Background Trichobezoars are a rare gastric foreign body composed of ingested hair, predominantly occurring in young females with trichotillomania. Surgical intervention remains the definitive treatment, as endoscopic removal is rarely successful unless the trichobezoar is small. Laparotomy allows safe en bloc removal, whereas minimally invasive approaches reduce incision size and length of hospital stay but often require piecemeal extraction for large trichobezoars, increasing the risk of intraperitoneal contamination. A laparoscopic-assisted approach may therefore represent a pragmatic compromise, facilitating minimally invasive access whilst minimising the risk of contamination. Case We present a case including intraoperative photography with consent of a 16-year-old female with a background of trichotillomania with epigastric pain and nausea to Tauranga Hospital. An abdominal x-ray was performed, with findings suggestive of a trichobezoar. Gastroscopy demonstrated a large trichobezoar with a superficial gastric ulcer that was too large to be removed endoscopically. The patient proceeded to the theatre for laparoscopic-assisted removal. An anterior gastrostomy was performed laparoscopically, followed by extraction of the trichobezoar through a wound-protected mini-laparotomy. The postoperative course was uneventful, and follow-up gastroscopy demonstrated healing of the gastric ulcer. Conclusions This case demonstrates that a laparoscopic-assisted approach allows for safe extraction of large trichobezoars, offering a practical operative strategy for this rare condition.