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      Laparoscopic Cholecystectomy in a Patient with Situs Inversus Totalis: Feasibility and Technical Difficulties

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          Abstract

          Situs inversus is a rare anomaly characterized by transposition of organs to the opposite side of the body. In patients with this anomaly, cholelithiasis is observed with a frequency similar to that in the normal population. Herein, we report on a patient with situs inversus totalis who underwent laparoscopic cholecystectomy for mucocele of the gallbladder. Diagnostic pitfalls and technical difficulties of the operation with technical options are discussed in the context of the available literature. Difficulty is encountered particularly in skeletonizing the structures in Calot's triangle, which consumes extra time and is more demanding than in patients with a normally located gallbladder. A summary of an additional 32 similar cases reported in the medical literature is also presented.

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          Laparoscopic cholecystectomy in situs inversus totalis: The importance of being left-handed.

          C L Ronchera-Oms, J Badia (2003)
          Since laparoscopic cholecystectomy has become the standard procedure for the treatment of gallstone disease, several cases have been reported in patients with situs inversus. These cases require more technically demanding procedures due to the symmetrical disposition of the anatomy. Thus, handedness could influence the performance of these operations. The two of us (L.M.O.) and (J.M.B.), a right-handed and a left-handed surgeon, respectively, placed the instruments in reverse mode from that used in orthotopic patients. The right-handed surgeon felt more impairment when dissecting with his left hand and decided to cross the instruments within the abdomen. The left-handed surgeon was able to alternate the performance of the dissection maneuvers between the right and left hands. Surgical procedures are apparently designed for right-handed surgeons and can be approached by the left-handed in alternative ways. In fact, the accommodation of laparoscopic cholecystectomy to left-handedness has been described in the literature. The rare opportunity to operate in a symmetrical way allows the right-handed surgeon to understand the absence of comfort and ergonomy often experienced by left-handed colleagues.
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            Laparoscopic cholecystectomy in a 39-year-old female with situs inversus.

            Antonio C L Campos, E Sipes (1990)
            Kartagener syndrome consists of situs inversus, chronic sinusitis, and bronchiectasis. A 39-year-old woman known to have Kartagener syndrome presented with complaints of left upper abdominal quadrant pain. Suspicion of cholelithiasis was confirmed with ultrasound and oral cholecystogram. The patient underwent a laparoscopic cholecystectomy. Standard techniques were modified in mirror image fashion to provide access to the left upper quadrant. This unusual presentation of chronic calculus cholecystitis in a patient with Kartagener syndrome demonstrates the adaptability of laparoscopic cholecystectomy technique.
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              Laparoscopic cholecystectomy in situs inversus totalis: a case report

              Damian McKay, Geoffrey Blake (2005)
              Background Laparoscopic cholecystectomy is one of the commonest surgical procedures carried out in the world today. Occasionally patients present with undiagnosed situs inversus and acute cholecystitis. We discuss one such case and outline how the diagnosis was made and the pitfalls encountered during surgery and how they were overcome. Case presentation A 32 year old female presented to our department with epigastric pain radiating through to the back. A diagnosis of acute cholecystitis in a patient with situs inversus totalis was made following clinical examination and radiological investigation. Laparoscopic cholecystectomy was subsequently performed and the patient made an uneventful recovery. Conclusion Situs inversus presenting with acute cholecystitis is very rare. The surgeon must appreciate that care should be taken to set up the operating theatre in the mirror image of the normal set-up for cholecystectomy, and that right handed surgeons must modify their technique to adapt to the mirror image anatomy.
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                Author and article information

                Journal
                Journal ID (nlm-ta): JSLS
                Journal ID (iso-abbrev): JSLS
                Journal ID (hwp): jsls
                Journal ID (pmc): jsls
                Journal ID (publisher-id): JSLS
                Title: JSLS : Journal of the Society of Laparoendoscopic Surgeons
                Publisher: Society of Laparoendoscopic Surgeons (Miami, FL )
                ISSN (Print): 1086-8089
                ISSN (Electronic): 1938-3797
                Publication date (Print): Jul-Sep 2006
                Volume: 10
                Issue: 3
                Pages: 386-391
                Affiliations
                Department of Surgery, Sultan Qaboos University Hospital, Muscat, Oman.
                Author notes
                Address reprint requests to: Norman Machado, Consultant/Department of Surgery, Sultan Qaboos University Hospital, PO Box 38, Postal code 123, Muscat/OMAN. Fax: 00 968 24413851, E-mail: norman@ 123456omantel.net.om
                Article
                PMC ID: 3015698
                PubMed ID: 17212902
                SO-VID: 2faf2ca4-69c5-41b3-bb7f-1b1b2708cf06
                Copyright © © 2006 by JSLS, Journal of the Society of Laparoendoscopic Surgeons.
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License ( http://creativecommons.org/licenses/by-nc-nd/3.0/), which permits for noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited and is not altered in any way.

                History
                Categories
                Subject: Case Reports

                ScienceOpen disciplines: Surgery
                Keywords: mri,situs inversus totalis,laparoscopic cholecystectomy
                Data availability:
                ScienceOpen disciplines: Surgery
                Keywords: mri, situs inversus totalis, laparoscopic cholecystectomy

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