title: A modified minimally invasive technique for the surgical management of large trichobezoars.
abstract: BACKGROUND
  Trichobezoar which were traditionally managed by open surgical retrieval are now often managed by minimally invasive surgical approach. Removal of a large trichobezoar by laparoscopy, however, needs an incision (usually 4-5 cm in size) for specimen removal and has the risk of intra-peritoneal spillage of hair and inspissated secretions.
  
  
  METHODS
  The present paper describes a modified laparoscopy-assisted technique with temporary gastrocutaneopexy for the effective removal of a large trichobezoar using a camera port and a 4-5 cm incision (which is similar to that needed for specimen removal during laparoscopy).
  
  
  RESULTS
  Three patients with large trichobezoar were managed with the described technique. The average duration of surgery was 45 (30-60) min and the intraoperative blood loss was minimal. There was no peritoneal spillage and the trichobezoar could be retrieved through a 4-5 cm incision in all patients. All had an uneventful recovery and at a median followup of 6 months had excellent cosmetic and functional results.
  
  
  CONCLUSIONS
  The described technique is a minimally invasive alternative for trichobezoar removal. There is no risk of peritoneal contamination and the technical ease and short operative time in addition to an incision limited to size required for the specimen removal, makes it an attractive option.
authors.affiliation: Department of GI Surgery, GB Pant Hospital & MAM College, New Delhi, India.
authors.forename: Amit
authors.initials: A
authors.lastname: Javed
authors.forename: Anil K
authors.initials: AK
authors.lastname: Agarwal
keywords: Limited incision; bezoar; gastric; hair ball; laparoscopy; rapunzel syndrome; trichobezoar; trichotillomania