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.

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