J Korean Surg Soc.  2011 Dec;81(Suppl 1):S34-S38. 10.4174/jkss.2011.81.Suppl1.S34.

Laparoscopy-assisted distal gastrectomy for early gastric cancer and laparoscopic cholecystectomy for gallstone with situs inversus totalis: a case report

• Seo KW
• Yoon KY

• KMID: 1445782
• DOI: http://doi.org/10.4174/jkss.2011.81.Suppl1.S34

Abstract

We report our case of laparoscopy-assisted distal gastrectomy with D1 + beta lymph node dissection for a patient with early gastric cancer and laparoscopic cholecystectomy for gallstone with situs inversus totalis. A superficial elevated lesion was found on the lesser curvature of the antrum. The preoperative diagnosis was cStage IA (cT1, cN0, cH0, cP0, cM0). A 1 cm-sized gallstone was found in the fundus through upper abdominal ultrasound. A laparoscopy-assisted distal gastrectomy with standard D2 lymph node dissection for early gastric cancer and laparoscopic cholecystectomy was successfully performed by not shifting the monitor to the left and right and not changing operator's position without additional blood loss and time. The number of retrieved lymph nodes was 36. We have not found any abnormal course of blood vessels except for the right/left inversion. Billroth I reconstruction was performed through end-to-side anastomosis. Based on a histopathological examination, a 1.5 x 1.5 cm, submucosal (sm3), moderately differentiated adenocarcinoma (pT1, pN0, sH0, sP0, sM0, stage IA) was diagnosed. The postoperative course was favorable and the patient was discharged on postoperative day 7.

Keyword

Laparoscopy-assisted distal gastrectomy; Laparoscopic cholecystectomy; Situs inversus

MeSH Terms

Adenocarcinoma
Blood Vessels
Cholecystectomy, Laparoscopic
Gallstones
Gastrectomy
Gastroenterostomy
Humans
Lymph Node Excision
Lymph Nodes
Organothiophosphorus Compounds
Situs Inversus
Stomach Neoplasms
Organothiophosphorus Compounds

Figure

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  Fig. 1 Upper esophagogastroduodenoscopy showed slightly elevated lesion with central slightly depressed lesion in the lesser curvature of midantrum. Tissue biopsy showed well-differentiated tubular adenocarcinoma.

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  Fig. 2 Chest radiography showed dextrocardia.

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  Fig. 3 Abdominal computed tomography showed that all intraabdominal organs were positioned inversely in a mirror image way.

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  Fig. 4 Abdominal ultrasonography showed single dependent echogenic foci with posterior acoustic shadowing consistent with gallstone.

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  Fig. 5 The sites of trocar placement. A trocar for camera was inserted into the subumbilical area by open technique.

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  Fig. 6 Initially, laparoscopic view showed the inversion of intraabdominal organs.

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  Fig. 7 Right gastroepiploic artery located on the left side was divided with double clips, allowing a dissection of station 6 lymph node.

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  Fig. 8 Left gastric artery located on the right side was divided with double clips, allowing a dissection of station 9 lymph node.

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  Fig. 9 Laparoscopic cholecystectomy was performed successfully without injury of common bile duct. Transected duodenum was seen in the lower part.

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  Fig. 10 Laparoscopic view showed completion of Billroth I reconstruction and cholecystectomy.

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  Fig. 11 A slightly elevated lesion with centrally depressed lesion in the midantrum, which measured 1.5 × 1.5 cm.

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