Ann Hepatobiliary Pancreat Surg.  2017 May;21(2):84-87. 10.14701/ahbps.2017.21.2.84.

Laparoscopic cholecystectomy in a case of situs inversus totalis: a review of technical challenges and adaptations

• Alam A
• Santra A

• KMID: 2379106
• DOI: http://doi.org/10.14701/ahbps.2017.21.2.84

Abstract

Situs inversus totalis is a rare congenital condition, characterized by the transposition of the thoracic and abdominal viscera, resulting in a mirror image of normal anatomy. Even though situs inversus does not predispose to gall stones, a laparoscopic cholecystectomy, in a case of situs inversus, can prove to be a technically challenging procedure, especially for the right-handed surgeon. In this case report, we present an unusual case of cholelithiasis in a patient with situs inversus totalis. A laparoscopic cholecystectomy, which is considered the gold standard procedure for symptomatic gallstones, was performed. The technical challenges that were anticipated due to anatomical anomalies were managed by various preoperative and intraoperative modifications. Through this present case report, we concluded that a laparoscopic cholecystectomy is a feasible and safe procedure in patients with situs inversus totalis and can be precisely performed by a right-handed surgeon, with necessary adaptations.

Keyword

Laparoscopic cholecystectomy; Situs inversus totalis; Adaptations

MeSH Terms

Cholecystectomy, Laparoscopic*
Cholelithiasis
Gallstones
Humans
Situs Inversus*
Viscera

Figure

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  Fig. 1 Chest X-ray (PA view) showing dextrocardia.

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  Fig. 2 Coronal section of computed tomography scan showing the liver on the left and the stomach and the heart on the right.

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  Fig. 3 Section of computed tomography scan showing reversed positions of the viscera.

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  Fig. 4 Operation field photograph showing ports placed in the mirror positions.

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  Fig. 5 Intraoperative photograph showing the common bile duct, cystic duct, and cystic artery.

Reference

1. Yokoyama T, Copeland NG, Jenkins NA, Montgomery CA, Elder FF, Overbeek PA. Reversal of left-right asymmetry: a situs inversus mutation. Science. 1993; 260:679–682.

2. Gedda L, Sciacca A, Brenci G, Villatico S, Bonanni G, Gueli N, et al. Situs viscerum specularis in monozygotic twins. Acta Genet Med Gemellol (Roma). 1984; 33:81–85.

3. Yaghan RJ, Gharaibeh KI, Hammori S. Feasibility of laparoscopic cholecystectomy in situs inversus. J Laparoendosc Adv Surg Tech A. 2001; 11:233–237.

4. Takei HT, Maxwell JG, Clancy TV, Tinsley EA. Laparoscopic cholecystectomy in situs inversus totalis. J Laparoendosc Surg. 1992; 2:171–176.

5. Hall TC, Barandiaran J, Perry EP. Laparoscopic cholecystectomy in situs inversus totalis: is it safe? Ann R Coll Surg Engl. 2010; 92:W30–W32.

6. Oms LM, Badia JM. Laparoscopic cholecystectomy in situs inversus totalis: The importance of being left-handed. Surg Endosc. 2003; 17:1859–1861.

7. McKay D, Blake G. Laparoscopic cholecystectomy in situs inversus totalis: a case report. BMC Surg. 2005; 5:5.

8. Iskandar ME, Radzio A, Krikhely M, Leitman IM. Laparoscopic cholecystectomy for a left-sided gallbladder. World J Gastroenterol. 2013; 19:5925–5928.

9. Crosher RF, Harnarayan P, Bremner DN. Laparoscopic cholecystectomy in situs inversus totalis. J R Coll Surg Edinb. 1996; 41:183–184.

10. Campos L, Sipes E. Laparoscopic cholecystectomy in a 39-year-old female with situs inversus. J Laparoendosc Surg. 1991; 1:123–125. discussion 126.

11. Moirangthem GS, Singh CA, Charaborty G, Lokendra K, Prabhu T. Laparoscopic cholecystectomy in a patient of situs inversus at regional institute of medical sciences (RIMS). J Med Soc. 2014; 28:60–62.

12. Arya SV, Das A, Singh S, Kalwaniya DS, Sharma A, Thukral BB. Technical difficulties and its remedies in laparoscopic cholecystectomy in situs inversus totalis: a rare case report. Int J Surg Case Rep. 2013; 4:727–730.