Laparoscopic cholecystectomy in a patient with situs inversus totalis

Abstract

Currently, laparoscopic cholecystectomy is an undoubtfully optimal treatment of cholelithiasis. What about performing this procedure on a patient with situs inversus totalis and what are the difficulties of this operation for a right-handed surgeon? We presented a 35-year-old man with unknown situs inversus totalis who was admitted with epigastric pain and digestive problems. Ultrasonography and computed tomography of the abdomen confirmed the diagnosis of a gallstone. Besides, the liver and gallbladder were on the left side and the spleen was on the right. All systems were left-right reversal as mirror image in all diagnostic studies. Laparoscopic cholecystectomy was safely performed, despite of difficulties of situs inversus. The patient was discharged on postoperative day 1. It should be considered that existence of other anomalies may easily cause uninvited injuries. In the patients with situs inversus, laparoscopic cholecystectomy can be safely managed by an experienced surgeon through laparoscopy, and also hepatobiliary surgery.

Technical Challenges in Laparoscopic Cholecystectomy in Situs Inversus

“…Preoperative imaging can help in identifying vascular and biliary anatomy and anomalies. 2 The surgeon has to be meticulous in his or her dissection and keep on reminding him-or herself about the mirror-image anatomy at every step to prevent complications.…”

“…The majority of reports describe that right-handed surgeons cross instruments within the peritoneal cavity to dissect with the right hand. 2 There is one interesting report of a comparison between a lefthanded and a right-handed surgeon, where the left-handed surgeon did not face any problem in dissection because of better dexterity between two hands, as both his hands had …”

Anesthetic management of a patient with situs inversus posted for laparoscopic cholecystectomy

“…Situs inversus on its own is not pathological; however, it may be associated with cardio-respiratory, hepatic pancreaticobiliary, gastro intestinal, neurological, orthopedic and urological anomalies. 3,4 The association of situs inversus totalis with syndromes such as Kartagener's syndrome, cardiac anomalies, spleen malformations and other such clinical entities makes the clinical scenario extremely challenging for the concerned anesthesiologist. 5 The normal development requires a 270 degree counter clockwise rotation that yields the normal anatomy.…”

Tratamento cirúrgico em paciente com situs inversus totalis após ferimento por arma de fogo: relato de caso

“…It can be partial (only one cavity) or with total abdominal and thoracic organs affected 1 .The first case was described in 1600 by Fabricius 2 . Incidence of 1/10000-50000 live births.…”

“…Incidence of 1/10000-50000 live births. This anatomical anomaly does not affect survival and is not considered pre-malignant 2,3 . It is usually diagnosed incidentally with imaging.…”