Ann Surg Treat Res.  2019 Dec;97(6):302-308. 10.4174/astr.2019.97.6.302.

Clinical significance and characteristics of left-sided gallbladder: case series study of 10 patients

• Lee DH
• Kim D
• Park YH
• Kim JS

• KMID: 2464786
• DOI: http://doi.org/10.4174/astr.2019.97.6.302

Abstract

PURPOSE
The aims of this case series study were to review the 10 patients who were diagnosed with left-sided gallbladder and analyze their anatomic variations in the bile duct, portal vein, and hepatic vessels.
METHODS
In this case series study, 10 patients with left-sided gallbladder were retrospectively analyzed at 2 tertiary referral centers between April 2004 and May 2019.
RESULTS
Mean age was 61.1 years; there were 7 women and 3 men. Ten patients underwent laparoscopic cholecystectomy for acute cholecystitis or symptomatic gallbladder stone. The mean operation time was 77.2 minutes. Three ports were used in laparoscopic cholecystectomy procedures. The mean postoperative hospital stay was 3.5 days, and there were no cases of surgery-related morbidity. Two patients had type 1 bile duct and 3 had type 3 bile duct (2 type 3B and 1 type 3A). The right posterior portal vein as the first branch of the main portal vein was observed in all patients. Segment IV branches of the left portal vein crossing over to the segment VIII territory were observed in 7 of the 10 patients.
CONCLUSION
Although left-sided gallbladder is a very rare disease, it is possible to diagnose it preoperatively and perform laparoscopic cholecystectomy safely by adjusting port position. The common important features of left-sided gallbladder include distribution of the left portal vein crossing over to the right side of the liver and increased size of the left portal vein. These variations may have important clinical implications in the management of hepatic resection including donor hepatectomy.

Keyword

Anatomic variation; Hepatectomy; Laparoscopic cholecystectomy

MeSH Terms

Anatomic Variation
Bile Ducts
Cholecystectomy, Laparoscopic
Cholecystitis, Acute
Crossing Over, Genetic
Female
Gallbladder*
Hepatectomy
Humans
Length of Stay
Liver
Male
Portal Vein
Rare Diseases
Retrospective Studies
Tertiary Care Centers
Tissue Donors

Figure

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  Fig. 1 Computed tomography image of left-sided gallbladder. The gallbladder (GB) was located on the left side of the round ligament (RL, black arrow) without situs inversus viscerum.

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  Fig. 2 Magnetic resonance cholangiopancreatography images of left-sided gallbladder. (A) Drainage of the right posterior segmental duct (white arrow) into the common hepatic duct (type 3B bile duct). (B) Drainage of the right posterior segmental duct (white arrow) into the left hepatic duct (type 3A bile duct).

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  Fig. 3 Laparoscopic working port locations of laparoscopic cholecystectomy for left-sided gallbladder patients. (A) Laparoscopic working port location in conventional laparoscopic cholecystectomy. (B) Modified laparoscopic working port location of laparoscopic cholecystectomy for left-sided gallbladder patients.

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  Fig. 4 Intraoperative images of left-sided gallbladder. (A) Laparoscopic view of left-sided gallbladder. (B) The second laparoscopic port (for the left hand) was inserted in the right upper quadrant of the abdomen. (C) The gallbladder bed was located to the left of the falciform ligament. (D) The third laparoscopic port (for the right hand) was inserted in the left upper quadrant of the abdomen. (E) Dissection of Calot's triangle. (F) The cystic duct and vessels of left-sided gallbladder.

• 

  Fig. 5 CT images of portal vein variation. (A) Right posterior portal vein (white arrow) as the first branch of the main portal vein. (B) Segment IV branch (white arrow) of left portal vein crossing over to segment VIII territory.

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