Turki Al Qurashi, MD1, Asem Ghasoup, MD, FACS, MRCPS1, Omar Sadieh, MD, FACS, MRCPS2, Abdul Rahman Al Abas, MD1. 1security forces hospital-Makkah, 2Saad Specialty Hospital
Keywords: Left sided gallbladder, Laparoscopic cholecystectomy, Situs inversus, Sigle port.
Introduction:
Laparoscopic cholecystectomy is one of the most common surgical procedures carried out in the world nowadays. While anatomical abnormalities of the biliary system are common; abnormal location of the gallbladder is extremely rare. In published literatures, there is only around 40 cases reported in the pre-laparoscopic era and almost the same number of cases performed with standard laparoscopic cholecystectomy for patients with situs inversus.
Patients and methods:
In this study, three patients were diagnosed as situs inversus totalis with cholelithiasis , all patients underwent full history taking, complete physical examination, abdominal ultrasound, computerized tomography (CT) and Laboratory investigation that includes; complete blood count, liver functions and coagulation profile.
Technique and Results:
Laparoscopic cholecystectomy performed for the first case with the 4-trocar Technique, the second case 3-trocar technique and the last one using single port technique. The operative team and laparoscopic devices were located in the theater as a mirror image configuration of normal laparoscopic cholecystectomy. The pneumoperitoneum (CO2) insufflated through veress needle at the subumblical incission maintainig pressure around 12 mmHg. The mean operative time was 30±20.7 minutes with no significant blood loss. All patients passed uneventful postoperative course without any complication and discharged home on the first day post surgery.
Conclusion:
Laparoscopic cholecystectomy, convention or single port incision, for patients with situs inversus totalis is feasible and can be safely performed in the presence of an experienced surgeon.
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