J Gastric Cancer.  2013 Dec;13(4):266-272.

Laparoscopic Distal Gastrectomy in a Patient with Situs Inversus Totalis: A Case Report

• Min SH
• Lee CM
• Jung HJ
• Lee KG
• Suh YS
• Shin CI
• Kim HH
• Yang HK

Abstract

We report our experience with two cases of situs inversus totalis, both involving patients diagnosed with gastric cancer. These were a 52-year-old male with a preoperative staging of cT1bN0M0 and a 68-year-old male with a staging of cT2N0M0, both of whom underwent surgery. The former was found to have vascular anomalies in the preoperative computed tomography, so we performed a computed tomography angiography with three-dimensional reconstruction. Laparoscopy-assisted distal gastrectomy with Billroth I anastomosis was performed with D1+ lymph node dissection, and a small laparotomy was made for extracorporeal anastomosis. In contrast, the latter case showed no vascular anomalies in the preoperative computed tomography, and totally laparoscopic distal gastrectomy with delta anastomosis was performed with D1+ lymph node dissection. There were no intraoperative problems in either patient and they were discharged without postoperative complications. Histopathological examination revealed a poorly differentiated adenocarcinoma (pT2N0M0) and a well-differentiated adenocarcinoma (pT1aN0M0), respectively.

Keyword

Situs inversus totalis; Laparoscopic-assisted gastrectomy; Gastric cancer; Lymph node dissection

MeSH Terms

Adenocarcinoma
Aged
Angiography
Gastrectomy*
Gastroenterostomy
Humans
Laparotomy
Lymph Node Excision
Male
Middle Aged
Postoperative Complications
Situs Inversus*
Stomach Neoplasms

Figure

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  Fig. 1 Computed tomography showing transposition of the abdominal organs in case 1 (A), and case 2 (C). (B, D) Esophagogastroduodenoscopy image showing the lesion on the mid antrum, lesser curvature in case 1 (B), and on the mid antrum, anterior wall in case 2 (D).

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  Fig. 2 Case 1. Three-dimensional reconstruction image of computed tomography angiography showing two branches of the left gastric artery (arrowheads), right gastric artery from the celiac trunk, and replaced common hepatic artery from the superior mesenteric artery (A, B).

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  Fig. 3 The placement of ports in (A) case 1, (B) case 2. A 7 cm incision is made below the xyphoid process for extracorporeal anastomosis (A). An extension of the umbilical incision is made for specimen extraction only (B).

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  Fig. 4 Case 1. (A) Initial laparoscopic view showing transposition of abdominal organs. (B) The ligated right gastroepiploic artery and vein. The ligated coronary vein. (C) Anatomic variation in the 1st and 2nd branch of the left gastric artery is apparent. (D) The ligated 1st branch of the left gastric artery, right gastric artery and coronary vein. (E) The wound after Billroth I anastomosis and Fibrin glue had been applied.

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  Fig. 5 Case 2. (A) Initial laparoscopic view showing transposition of abdominal organs. (B) Ligated right gastroepiploic artery and vein. (C) Suprapancreatic lymph node dissection with ligated left gastric artery. (D) After delta-shaped anastomosis.

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