P Senthilnathan, R Parthasarathi, S Rajapandian, P Praveen Raj, Anand Vijai, V P Nalankilli, G Srivatsan, Sandeep Sabnis, C Palanivelu. GEM Hospital & Research Centre
76 year lady, a known case of Situs inversus totalis underwent open cholecystectomy elsewhere 6 months back. Follow up at our centre for pain abdomen revealed common bile duct calculi and small residual gall bladder containing small calculi. ERCP was attempted but procedure was deferred due to non visualization of ampulla along with periampullary diverticulum. Hence we planned for laparoscopic bile duct exploration and completion cholecystectomy.
Surgery details: Patient was placed in supine and split leg position. Ports were of mirror image of routine conventional ports used in lap choledochoduodenostomy. Monitor was kept on left shoulder side .To prevent disorientation due to situs inversus, a novel method was used by keeping a mirror image by the side of the monitor which reflects image from the monitor kept at the back of the team. The gall bladder stump was reached and found to be inflamed and fibrotic. CBD opened longitudinally after placing stay sutures and found to have multiple calculi which were cleared by balloon sweep and saline wash. Check cholangiogram was done and stone clearance confirmed. Completion cholecystectomy was done by mobilizing gall bladder remnant from liver bed. Gall bladder stump was sutured with 3-0 PDS suture. Duodenum Kocherized and side to side choledochoduodenostomy was done in single layer using interrupted 4-0 PDS sutures. Stone and specimen retrieved.
Conclusion: Laparoscopic completion cholecystectomy with choledochoduodenostomy in patient with situs inversus totalis highlights the technical details and novel way of overcoming the disorientation by placing the mirror image by the side.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80849
Program Number: V172
Presentation Session: Video Loop
Presentation Type: VideoLoop