Laparoscopic Cholecystectomy in situs inversus totalis with literature review

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.