Laparoscopic-assisted removal of gastric trichobezoar by a Novel Technique

Trichobezoar are mass of hair in the digestive tract caused by ingestion of hairs (trichophagia)mostly as a result of psychiatric disorders. The management of Trichobezoar includes psychiatric treatment to stop trichophagia and removal of trichobezoar for the GIT. Several techniques have been used for removal of Trichobezoar from the gut including endoscopy, laparotomy and laparoscopy. Laparoscopic retrieval is associated with minimal trauma and early recovery. The conventional laparoscopic removal of whole mass of hairs using endobag is associated with contamination of abdominal cavity, larger scars and possible infection. We suggest a simple laparoscopic assisted technique of Trichobezoar removal. In this technique two ports are used one umbilical port and one right abdomen port. The stomach is visualized with the right port used as camera port. Using umbilical port stomach is grasped in an avascular area and pulled out through the umbilicus. The umbilical incision is about 1.5 cm. The stomach is opened along the greater curvature away from the marginal vessels and temporary sutured to umbilical wound. Two langenbeck retractors are used to open the wound A strong grasper is then used to remove the hairs from the stomach piecemeally undirect vision. Any residual hairs are removed by direct visualization of the stomach lumen by the laparoscope. It is possible to retrieve the whole mass by this technique leaving minimal scarring and early recovery. We are reporting this technique in two patient with excellent recovery and minimal scarring.