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Lakhey P, Shrestha M, Sharma R, Lakhey PJ. Laparoscopic Cholecystectomy in Situs Inversus Totalis: A Case Report. Clin Case Rep 2025; 13:e70222. [PMID: 39967839 PMCID: PMC11833166 DOI: 10.1002/ccr3.70222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2024] [Revised: 02/04/2025] [Accepted: 02/09/2025] [Indexed: 02/20/2025] Open
Abstract
Situs inversus totalis is a rare condition characterized by the mirror image of the normal abdominal and thoracic viscera. Since the gallbladder is located in the left upper quadrant in this subset of patients, the diagnosis of symptomatic cholelithiasis poses a difficulty. Similarly, laparoscopic cholecystectomy in these patients is more demanding and presents technical challenges, especially for right-handed surgeons. Herein, we report a case of a 30-year-old female who was a known case of situs inversus totalis and was diagnosed with symptomatic cholelithiasis and subsequently underwent laparoscopic cholecystectomy with an uneventful post-operative period. The challenge while performing laparoscopic cholecystectomy in patients with situs inversus totalis calls for appropriate perioperative preparation and necessary modifications in the operative setup for the safe and successful operation of the patient, which is discussed in this report.
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Affiliation(s)
- Prapti Lakhey
- Third Year Medical StudentNepal Medical College Teaching HospitalKathmanduNepal
| | | | | | - Paleswan Joshi Lakhey
- Department of General SurgeryB&B HospitalLalitpurNepal
- Department of Surgical GastroenterologyTribhuvan University Teaching Hospital Maharajgunj Medical Campus, Institute of MedicineKathmanduNepal
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Enciu O, Toma EA, Tulin A, Georgescu DE, Miron A. Look beyond the Mirror: Laparoscopic Cholecystectomy in Situs Inversus Totalis-A Systematic Review and Meta-Analysis (and Report of New Technique). Diagnostics (Basel) 2022; 12:1265. [PMID: 35626419 PMCID: PMC9140146 DOI: 10.3390/diagnostics12051265] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 05/10/2022] [Accepted: 05/17/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Laparoscopic cholecystectomy in situs inversus totalis (SIT) is a technically and physically demanding procedure for surgeons and there is still a lack of consensus regarding the best technical approach in such cases. We conducted a systematic review and meta-analysis to evaluate port placement, the dominant hand of the surgeon, preoperative imaging, morbidity, and mortality. METHODS We searched MEDLINE, SCOPUS, Web of Science, and the Cochrane Library for studies of patients with SIT that underwent laparoscopic cholecystectomy. Of 387 identified records, 101 met our inclusion criteria, all of them case reports or case series of maximum of 6 patients. RESULTS Out of the 121 patients included in the analysis, 94 were operated on using a "mirrored American" technique, 12 using the "Mirrored French", 9 employed single-port techniques, and 6 described novel port placements. Even though most surgeries were conducted by a right-handed surgeon (93 cases), surgeries performed by the seven left-handed surgeons yielded shorter intervention times (p = 0.024). Preoperative imaging (CT, MRI, MRCP, ERCP) also correlated with a lower duration of surgery (p = 0.038. Length of stay was associated with the type of disease, but not with other studied endpoints. Morbidity was less than 1%, and conversion rates and mortality were nil. CONCLUSIONS Cholecystectomy in SIT is a safe but challenging procedure and surgeons should prepare in advance for the unfamiliar aspects of completing such a task. While preoperative imaging and a left-handed surgeon are beneficial in terms of surgery length, when these are not available surgeons should focus on achieving the most comfortable setting based on their experience and tailor their approach to the patient at hand. Further studies are needed in order to properly describe and evaluate intraoperative findings as well as surgeon-dependent factors that could improve future recommendations.
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Affiliation(s)
- Octavian Enciu
- Department of Surgery, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (O.E.); (D.E.G.); (A.M.)
- General Surgery Department, Elias Emergency University Hospital, 011461 Bucharest, Romania
| | - Elena Adelina Toma
- Department of Surgery, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (O.E.); (D.E.G.); (A.M.)
- General Surgery Department, Elias Emergency University Hospital, 011461 Bucharest, Romania
| | - Adrian Tulin
- Faculty of Medicine—Discipline of Anatomy, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania;
| | - Dragos Eugen Georgescu
- Department of Surgery, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (O.E.); (D.E.G.); (A.M.)
- I. Cantacuzino Clinical Hospital, 030167 Bucharest, Romania
| | - Adrian Miron
- Department of Surgery, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (O.E.); (D.E.G.); (A.M.)
- General Surgery Department, Elias Emergency University Hospital, 011461 Bucharest, Romania
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Palomba G, Dinuzzi VP, Manigrasso M, Milone M, De Palma GD, Aprea G. Laparoscopic Cholecystectomy with a Mixed Approach in a Patient with Kartagener Syndrome: Technical Report and Review of Literature. Indian J Surg 2021; 83:411-417. [DOI: 10.1007/s12262-020-02240-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 04/17/2020] [Indexed: 11/26/2022] Open
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Gelevski R, Jota G, Todorović L, Trajkovski G, Joksimović V, Trenčić B. Laparoscopic cholecystectomy in situs inversus totalis: A case report. ACTA FACULTATIS MEDICAE NAISSENSIS 2021. [DOI: 10.5937/afmnai38-30172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Situs inversus totalis represents a rare autosomal recessive morphological anomaly of the internal viscera, equally affecting both genders. The genetic defect occurs in the 2nd week of embryonic life, when a 270-degree clockwise rotation of the primitive digestive tube occurs. The incidence of calculosis of gallbladder in patients with situs inversus is the same as in the general population. A 61-year-old female patient with a history of four episodes of colicky, left hypochondrium and epigastric pain, without fever and jaundice, was admitted for elective laparoscopic cholecystectomy. CT of abdomen confirmed situs inversus totalis that was previously known to the patient. The patient was positioned in supine position and a mirror image configuration of the operating room was obtained, with surgeon and scrub nurse on the right side and assistant on the left side of the patient. Four trocars were introduced mirroring the standard position of the 5 mm trocars. During the dissection, second assistant was introduced for the laparoscope, due to the surgeon's limited motor skills in his left hand for delicate dissection, rendering him inapt to perform precise and safe dissection. The total operating time amounted to 110 minutes, which is three times longer than the standard operating time at our institution. The most critical point of the operation in constellation of situs inversus totalis is applying the clips, which requires precision and strength in the same moment. In the available literature, 40 open cholecystectomies before introduction of laparoscopy and 92 laparoscopic cholecystectomies were reported. To our knowledge, this is the first and the only reported laparoscopic cholecystectomy for situs inversus in North Macedonia.
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A rare acute abdomen case: Acute appendicitis in a patient with situs inversus totalis. JOURNAL OF SURGERY AND MEDICINE 2019. [DOI: 10.28982/josam.570128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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6
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Chaouch MA, Jerraya H, Dougaz MW, Nouira R, Dziri C. A Systematic Review of Laparoscopic Cholecystectomy in Situs Inversus. J INVEST SURG 2019; 34:324-333. [DOI: 10.1080/08941939.2019.1622822] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
| | - Hichem Jerraya
- Department of General Surgery B, Charles Nicolle Hospital, Tunis, Tunisia
| | | | - Ramzi Nouira
- Department of General Surgery B, Charles Nicolle Hospital, Tunis, Tunisia
| | - Chadli Dziri
- Department of General Surgery B, Charles Nicolle Hospital, Tunis, Tunisia
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7
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Laparoscopic cholecystectomy in situs inversus totalis: Case report with review of techniques. Int J Surg Case Rep 2019; 59:208-212. [PMID: 31181389 PMCID: PMC6556755 DOI: 10.1016/j.ijscr.2019.05.050] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 03/21/2019] [Accepted: 05/23/2019] [Indexed: 12/17/2022] Open
Abstract
SIT is a rare congenital anatomy with mirror image transposition of the viscera. The underlying anatomical variation poses a challenge in the diagnosis and management of cholelithiasis In patient with SIT. Laparoscopic cholecystectomy can be safely performed in these cases. It is considered technically challenging procedure and often requires alteration in the technique compared to the conventional laparoscopic cholecystectomy. Introduction Situs inversus totalis (SIT) is a congenital disorder in which the visceral organs are mirrored from their normal anatomical position. Diagnosis and management of cholelithiasis in patient with SIT poses a challenge due to the underlying anatomical variation. Presentation of case We report a case of a 40-year-old male patient who presented with an intermittent history of epigastric and left upper quadrant pain for one month. Clinical assessment and radiological investigations confirmed the presence of cholelithiasis with evidence of SIT. The patient underwent elective laparoscopic cholecystectomy with no complication and he had an uneventful recovery. Various intraoperative modification has been made to overcome the technical difficulties encountered due to the underlying anatomical variation. Discussion Since the first successful laparoscopic cholecystectomy in patient with SIT performed in 1991, 85 cases have been reporsted in the literature. Surgeons managed to overcome the technical difficulties by adopting various modification in the techniques compared to the conventional laparoscopic cholecystectomy. Conclusion The anatomical variation in SIT can influence the localization of symptoms in patient with cholelithiasis leading to a delay in diagnosis and management. Laparoscopic cholecystectomy can be safely performed in these cases. However, it is considered technically challenging procedure and often requires alteration in the technique.
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Takalkar YP, Koranne MS, Vashist KS, Khedekar PG, Garale MN, Rege SA, Dalvi AN. Laparoscopic cholecystectomy with choledochoduodenostomy in a patient with situs inversus totalis. J Minim Access Surg 2018; 14:241-243. [PMID: 29882522 PMCID: PMC6001295 DOI: 10.4103/jmas.jmas_122_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
A 50-year-old female presented to us with features of obstructive jaundice. Investigations revealed cholelithiasis with single large impacted calculus in the common bile duct (CBD) and significant dilatation of extrahepatic biliary tree. Incidentally, the patient was also detected to have situs inversus totalis (SIT). Attempt at extraction of the calculus in the CBD by endoscopic retrograde cholangiography failed, and a 7F stent was placed. The patient was subjected to laparoscopic cholecystectomy, CBD exploration with the extraction of the offending calculus and laparoscopic choledochoduodenostomy (LCDD). The patient had an uneventful recovery and is since discharged. PubMed search did not reveal LCDD in SIT as a procedure reported in literature to the best of our knowledge.
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Affiliation(s)
- Yogesh P Takalkar
- Department of General Surgery, Seth G S Medical College and King Edward VII Memorial Hospital, Mumbai, Maharashtra, India
| | - Mandar S Koranne
- Department of General Surgery, Seth G S Medical College and King Edward VII Memorial Hospital, Mumbai, Maharashtra, India
| | - Kumar S Vashist
- Department of General Surgery, Seth G S Medical College and King Edward VII Memorial Hospital, Mumbai, Maharashtra, India
| | - Pranalee G Khedekar
- Department of General Surgery, Seth G S Medical College and King Edward VII Memorial Hospital, Mumbai, Maharashtra, India
| | - Mahadeo N Garale
- Department of General Surgery, Seth G S Medical College and King Edward VII Memorial Hospital, Mumbai, Maharashtra, India
| | - Sameer A Rege
- Department of General Surgery, Seth G S Medical College and King Edward VII Memorial Hospital, Mumbai, Maharashtra, India
| | - Abhay N Dalvi
- Department of General Surgery, Seth G S Medical College and King Edward VII Memorial Hospital, Mumbai, Maharashtra, India
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9
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Karabay O, Gurbuz B, Zenger S, Balik E, Bugra D. Laparoscopic colon resection in patients with situs inversus totalis: Is it the same operation as in patients without situs inversus totalis? J Minim Access Surg 2018; 15:68-70. [PMID: 29737309 PMCID: PMC6293681 DOI: 10.4103/jmas.jmas_13_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Situs inversus totalis (SIT) is a rare condition. In this case, a patient who underwent laparoscopic anterior resection for repeated sigmoid colon diverticulitis with SIT was presented. Laparoscopy surgery in patients with this condition has some important technical differences than standard laparoscopic procedures. Therefore, it may be more appropriate to request surgical experience to perform safe laparoscopic surgery in patients with SIT.
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Affiliation(s)
- Onder Karabay
- Faculty of Health Sciences, Istinye University, Istanbul, Turkey
| | - Bulent Gurbuz
- Department of General Surgery, American Hospital, Istanbul, Turkey
| | - Serkan Zenger
- Department of General Surgery, American Hospital, Istanbul, Turkey
| | - Emre Balik
- Department of General Surgery, Koc University, Istanbul, Turkey
| | - Dursun Bugra
- Department of General Surgery, Koc University, Istanbul, Turkey
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10
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Xiang D, He J, Fan Z, Xiong F, Liu G, Chen S, Wen W, Li J, Ai J, Wan R, Wang G, Shi J. Situs inversus totalis with solid pseudopapillary pancreatic tumor: A case report and review of literature. Medicine (Baltimore) 2018; 97:e0205. [PMID: 29561447 PMCID: PMC5895343 DOI: 10.1097/md.0000000000010205] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
RATIONALE Situs inversus totalis (SIT) is a rare anatomical variation of the internal organs, and solid pseudopapillary tumor of the pancreas (SPTP) is a rare tissue type of pancreatic tumors, classified as benign or low-grade malignancy. However, to our knowledge, a patient with SIT and SPTP is extremely rare and has never been reported. PATIENT CONCERNS We retrospectively analyzed a case of SIT with SPTP in a 45-year-old woman. The main complaints were abdominal pain and sensation of heaviness for 2 weeks. There was tenderness and a mass that could be palpated in the right upper abdomen. DIAGNOSES Heart ultrasonography (USG), chest x-ray, computed tomography (CT), and contrast-enhanced computerized tomography (CECT) revealed a mirror-image dextrocardia and inversion of all abdominal viscera and a space-occupying lesion in the pancreas tail. Abdominal computed tomography angiography (CTA) showed no obvious abnormality of artery. The diagnosis of SPTP was finally made by postoperative pathological examination. INTERVENTIONS The patient underwent resection of the pancreatic body and tail and splenectomy via laparotomy to completely remove the tumor. OUTCOMES The patient was discharged with specific discomfort on postoperative day 7. At the 1.5-year follow-up, she recovered without issue. LESSONS Surgical resection remains the only effective treatment of SPTP. SIT with SPTP can be accurately diagnosed by heart USG, chest x-ray, CT, and CECT of the upper abdomen. Abdominal aorta CTA before surgery can decrease the injury risk of blood vessels.
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Affiliation(s)
- Deng Xiang
- Department of General Surgery, The First Affiliated Hospital of Nanchang University
| | - Jiannan He
- Department of General Surgery, The First Affiliated Hospital of Nanchang University
| | | | - Fangfang Xiong
- Basic Nursing Teaching and Research Office, Nanchang City Health School
| | - Gang Liu
- Department of General Surgery, The First Affiliated Hospital of Nanchang University
| | - Sufen Chen
- Department of General Surgery, The First Affiliated Hospital of Nanchang University
| | - Wu Wen
- Department of General Surgery, The First Affiliated Hospital of Nanchang University
| | - Jianfeng Li
- Department of General Surgery, The First Affiliated Hospital of Nanchang University
| | - Junhua Ai
- Department of General Surgery, The First Affiliated Hospital of Nanchang University
| | - Renhua Wan
- Department of General Surgery, The First Affiliated Hospital of Nanchang University
| | - Gongxian Wang
- Department of Urology Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Jun Shi
- Department of General Surgery, The First Affiliated Hospital of Nanchang University
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11
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Cao Y, Li J, Shen L, Wang J, Xia Z, Tao K, Wang G, Cai K. Gastric cancer in a situs inversus totalis patient with multiple intestinal and vessel variations related to gastrectomy surgery: A case report and literature review. Medicine (Baltimore) 2017; 96:e8209. [PMID: 28953685 PMCID: PMC5626328 DOI: 10.1097/md.0000000000008209] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 09/09/2017] [Accepted: 09/12/2017] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Situs inversus totalis (SIT) is a rare congenital anomaly characterized by complete inversion of the abdominal and thoracic organs, and often involves multiple genetic mutations. The most suitable surgical technique for patients with multiple vessel and organ variations as well as SIT remains unclear. Furthermore, there has been insufficient clinical evidence that demonstrates which surgical techniques achieve the best outcomes. Finally, the standard of care has not yet been determined. We present the case of a 60-year-old man with SIT, who was diagnosed with moderately and poorly differentiated adenocarcinoma at the gastroesophageal junction. We further describe the advantage of using robotic-assisted laparoscopic surgery in patients with this anomaly. PATIENT CONCERNS A 60-year-old man complained of pain in his upper abdomen for 3 months. Physical examination revealed an apex beat in the right fifth intercostal space, and vascular anomalies were noted on abdominal angiographic computed tomography. DIAGNOSES Moderately and poorly differentiated adenocarcinoma at the gastroesophageal junction with SIT. INTERVENTIONS Robot-assisted total gastrectomy with D2 lymph node dissection and hand-sewn Roux-en-Y anastomosis was performed. OUTCOMES The postoperative course was uneventful, and the patient was discharged on the seventh postoperative day. LESSONS Robotic surgery for gastric cancer is a safe and feasible alternative to laparoscopic surgery and it can be successfully used to treat gastric cancer in patients with SIT with multiple anatomic variations. As exemplified by our case, SIT might be accompanied by multiple anatomic variations. Detailed preoperative detailed imaging of the blood vessels and gastrointestinal tract is useful in these patients.
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12
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Alam A, Santra A. Laparoscopic cholecystectomy in a case of situs inversus totalis: a review of technical challenges and adaptations. Ann Hepatobiliary Pancreat Surg 2017; 21:84-87. [PMID: 28567452 PMCID: PMC5449369 DOI: 10.14701/ahbps.2017.21.2.84] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2016] [Revised: 01/27/2017] [Accepted: 02/02/2017] [Indexed: 11/17/2022] Open
Abstract
Situs inversus totalis is a rare congenital condition, characterized by the transposition of the thoracic and abdominal viscera, resulting in a mirror image of normal anatomy. Even though situs inversus does not predispose to gall stones, a laparoscopic cholecystectomy, in a case of situs inversus, can prove to be a technically challenging procedure, especially for the right-handed surgeon. In this case report, we present an unusual case of cholelithiasis in a patient with situs inversus totalis. A laparoscopic cholecystectomy, which is considered the gold standard procedure for symptomatic gallstones, was performed. The technical challenges that were anticipated due to anatomical anomalies were managed by various preoperative and intraoperative modifications. Through this present case report, we concluded that a laparoscopic cholecystectomy is a feasible and safe procedure in patients with situs inversus totalis and can be precisely performed by a right-handed surgeon, with necessary adaptations.
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Affiliation(s)
- Azhar Alam
- Department of Surgery, B.R. Singh Hospital and Centre for Medical Education and Research, Eastern Railways, Kolkata, West Bengal, India
| | - Abhijit Santra
- Department of Surgery, B.R. Singh Hospital and Centre for Medical Education and Research, Eastern Railways, Kolkata, West Bengal, India
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13
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Suh BJ. A Case of Gastric Cancer with Situs Inversus Totalis. Case Rep Oncol 2017; 10:130-135. [PMID: 28203176 PMCID: PMC5301127 DOI: 10.1159/000456539] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 01/16/2017] [Indexed: 12/18/2022] Open
Abstract
Situs inversus totalis (SIT) is a rare congenital anomaly that refers to a completely reversed location of the abdominal and thoracic organs. We report the case of 50-year-old man with gastric cancer and SIT who was diagnosed during a screening esophagogastroduodenoscopy. A chest X-ray, abdominopelvic computed tomography, and 18F-fluoro2-deoxyglucose-D-glucose-positron emission tomography scans revealed SIT. We performed a radical subtotal gastrectomy with D2 lymph node dissection. Advanced surgical skill is required to perform a precise lymphadenectomy in a patient with SIT by visualizing the exact mirror image of the anatomy during the operation. The patient had an uneventful intra- and postoperative course and was followed up at the outpatient department without any evidence of recurrence. In conclusion, surgery in a patient with gastric cancer and SIT can be safely performed by paying attention to the inverted anatomic structures during the operation.
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Affiliation(s)
- Byoung Jo Suh
- Department of Surgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
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14
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Uludag M, Kartal K, Aygun N. Laparoscopic adrenalectomy in a patient with situs inversus totalis. J Minim Access Surg 2017; 13:60-62. [PMID: 27251840 PMCID: PMC5206842 DOI: 10.4103/0972-9941.181775] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Situs inversus totalis(SIT) is a relatively rare condition involving transposition of both the abdominal and thoracic viscera. SIT typically presents as left to right reversal of the viscera combined with dextrocardia, while the individual organs function is normal. Although there are no obvious abnormalities in the function of transposed organs, anatomical irregularity causes important technical difficulties in the surgical treatment of these patients. In this study, we aim to report surgical challenges in laparoscopic adrenalectomy in a patient with SIT.
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Affiliation(s)
- Mehmet Uludag
- Department of General Surgery, Sisli Etfal Training and Research Hospital, Sisli, Istanbul 34371, Turkey
| | - Kinyas Kartal
- Department of General Surgery, Sisli Etfal Training and Research Hospital, Sisli, Istanbul 34371, Turkey
| | - Nurcihan Aygun
- Department of General Surgery, Sisli Etfal Training and Research Hospital, Sisli, Istanbul 34371, Turkey
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15
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Alsabek MB, Arafat S, Aldirani A. A case report of laparoscopic cholecystectomy in situs inversus totalis: Technique and anatomical variation. Int J Surg Case Rep 2016; 28:124-126. [PMID: 27701001 PMCID: PMC5048624 DOI: 10.1016/j.ijscr.2016.09.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Accepted: 09/12/2016] [Indexed: 01/28/2023] Open
Abstract
Situs Inversus Totalis (SIT) is a rare condition. Gallbladder diseases are difficult to diagnosed in SIT patients. Laparoscopic surgery is safe in SIT patients. Technical and Anatomical difficulties should be expected. Left-handed surgeons have advantages over Right-handed ones. Bachground Since the first laparoscopic cholecystectomy report in situs inversus totalis in 1991, the safety of this procedure has still been questionable. A few surgeons were preferred to perform an open cholecystectomy due to technical difficulties as well as various anatomical varieties that can be faced during surgery. Case presentation We report a case report of a 50 years old patient came with epigastric pain that radiated to her left shoulder, intermittent nausea, vomiting and bloating after some meals. She did not associate her symptoms with fatty food. She was a known case of situs inversus totalis and had a previous laparoscopic Nissen fundoplication that we performed 5 years ago. A laparoscopic cholecystectomy was performed by a left-handed surgeon, illustrating challenges, technique, and the advantages of left-handed surgeon over right-handed ones. Discussion After the first discovery of situs inversus totalis by Fabricus in the 1600 the standard procedure for cholelithiasis was open surgery. The introduction of the first laparoscopic cholecystectomy in patients with situs inversus put surgeons in challenge for performing laparoscopic rather than open surgery for patients with situs inversus diagnosed with gallbladder disease. Only 67 cases used laparoscopic cholecystectomy in treating situs inversus patients with cholelithiasis. Although technical difficulties and expected anatomical variation are the main challenges in those patients, the current literature confirms the safety of laparoscopy in such cases. Conclusion Despite having all these difficulties, handling this type of operations can be safe and uneventful especially with experienced surgeon.
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Affiliation(s)
- Mhd Belal Alsabek
- Department of surgery, Damascus General Hospital, Damascus, Syria; Department of surgery, Faculaty of Medicine, Syrian Private University (SPU), Syria.
| | - Shawqi Arafat
- Department of surgery, Damascus General Hospital, Damascus, Syria.
| | - Alaa Aldirani
- Department of surgery, Damascus General Hospital, Damascus, Syria.
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Xu JB, Xu G, Chen GF, Gu DH, Zhang JH, Qi FZ. Hepatocellular Carcinoma with Hypersplenic Thrombocytopenia and Situs Inversus Totalis: A Case Report. ACTA ACUST UNITED AC 2016; 31:134-136. [PMID: 28031104 DOI: 10.1016/s1001-9294(16)30039-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Jian-Bo Xu
- Department of General Surgery, Huai'an First People's Hospital, Nanjing Medical University, Huai'an, Jiangsu 223300, China
| | - Gang Xu
- Department of General Surgery, Huai'an First People's Hospital, Nanjing Medical University, Huai'an, Jiangsu 223300, China
| | - Guo-Feng Chen
- Department of General Surgery, Huai'an First People's Hospital, Nanjing Medical University, Huai'an, Jiangsu 223300, China
| | - Dian-Hua Gu
- Department of General Surgery, Huai'an First People's Hospital, Nanjing Medical University, Huai'an, Jiangsu 223300, China
| | - Jian-Huai Zhang
- Department of General Surgery, Huai'an First People's Hospital, Nanjing Medical University, Huai'an, Jiangsu 223300, China
| | - Fu-Zhen Qi
- Department of General Surgery, Huai'an First People's Hospital, Nanjing Medical University, Huai'an, Jiangsu 223300, China
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17
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Ustunyurt E, Cift T. Staging laparotomy for endometrial cancer in a patient with situs inversus totalis: A case report. Oncol Lett 2014; 8:1765-1767. [PMID: 25202406 PMCID: PMC4156176 DOI: 10.3892/ol.2014.2355] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 03/14/2014] [Indexed: 11/12/2022] Open
Abstract
Situs inversus is a rare congenital anomaly in which the organs are transposed from their normal site to the opposite side of the body. To the best of our knowledge, this is the first study of staging laparotomy performed in a patient with endometrial carcinoma and situs inversus totalis (SIT). This study presents a patient with early endometrial carcinoma with SIT who underwent staging laparotomy. Total abdominal hysterectomy with bilateral salphingoophorectomy, omentectomy and pelvic para-aortic lymph node dissection was successfully performed without additional blood loss and time. The number of retrieved lymph nodes was 47. No abnormal course of blood vessels except for the right/left inversion was found. The postoperative course was favorable and the patient was discharged eight days after surgery.
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Affiliation(s)
- Emin Ustunyurt
- Department of Obstetrics and Gynecology, Bursa Şevket Yilmaz Research and Education Hospital, Bursa, Nilüfer 16120, Turkey
| | - Tayfur Cift
- Department of Obstetrics and Gynecology, Bursa Şevket Yilmaz Research and Education Hospital, Bursa, Nilüfer 16120, Turkey
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18
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Alzahrani HA, Yamani NM. Gallbladder agenesis with a primary choledochal stone in a patient with situs inversus totalis. AMERICAN JOURNAL OF CASE REPORTS 2014; 15:185-8. [PMID: 24803979 PMCID: PMC4010620 DOI: 10.12659/ajcr.890523] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Accepted: 04/12/2014] [Indexed: 11/09/2022]
Abstract
Patient: Female, 68 Final Diagnosis: Gallbladder agenesis with situs inversus totalis Symptoms: Epigastric pain • jaundice Medication: — Clinical Procedure: — Specialty: Surgery
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Affiliation(s)
- Hassan A Alzahrani
- Department of Surgery, King Fahad National Guard Hospital, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Nizar M Yamani
- Department of Surgery, King Fahad National Guard Hospital, King Abdulaziz Medical City, Riyadh, Saudi Arabia
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19
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Salama IA, Abdullah MH, Houseni M. Laparoscopic cholecystectomy in situs inversus totalis: Feasibility and review of literature. Int J Surg Case Rep 2013; 4:711-5. [PMID: 23810920 DOI: 10.1016/j.ijscr.2013.02.030] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Revised: 02/04/2013] [Accepted: 02/27/2013] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Situs inversus totalis is a rare anomaly characterized by transposition of organs to the opposite site of the body. Laparoscopic cholecystectomy in those patients is technically more demanding and needs reorientation of visual-motor skills to left upper quadrant. PRESENTATION OF CASE Herein, we report a 10 year old boy presented with left hypochondrium and epigastric pain 2 months duration. The patient had not been diagnosed as situs inversus totalis before. The patient exhibit a left sided "Murphy's sign". Diagnosis of situs inversus totalis was confirmed with ultrasound, computerized tomography (CT) and magnetic resonant image (MRI) with presence of multiple gall bladder stones with no intra or extrabiliary duct dilatation. The patient underwent laparoscopic cholecystectomy for cholelithiasis. DISCUSSION Feasibility and technical difficulty in diagnosis and treatment of such case pose challenge problem due to the contra lateral disposition of the viscera. Difficulty is encountered in skelatonizing the structures in Calot's triangle, which consume extra time than normally located gall bladder. A summary of additional 50 similar cases reported up to date in the medical literature is also presented. CONCLUSION Laparoscopic cholecystectomy is feasible and should be done in situs inversus totalis by experienced laparoscopic surgeon, as changes in anatomical disposition of organ not only influence the localization of symptoms and signs arising from a diseased organ but also imposes special demands on the diagnosis and surgical skills of the surgeon.
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Affiliation(s)
- Ibrahim Abdelkader Salama
- Department of Hepatobilary Surgery, National Liver Institute, Menophyia University, Shiben Elkom, Egypt.
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20
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Demiryilmaz I, Yilmaz I, Albayrak Y, Peker K, Sahin A, Sekban N. Laparoscopic cholecystectomy in patients with situs inversus totalis: literature review of two patients. IRANIAN RED CRESCENT MEDICAL JOURNAL 2012; 14:826-8. [PMID: 23482252 PMCID: PMC3587875 DOI: 10.5812/ircmj.4806] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Revised: 06/23/2012] [Accepted: 07/11/2012] [Indexed: 11/16/2022]
Abstract
Situs inversus totalis is a rare condition, which presents difficulties in diagnosis and treatment of gallstones due to the reversal location of abdominal organs. In this article we present 2 cases of women in age of 51 and 55 years with situs inversus totalis and gallstones. There are described the clinical and imaging features, also the laparoscopic surgery with the difficulties encountered by right handed surgeon. In patients with situs inversus totalis, laparoscopic surgery may be performed safely by a surgeon with experience.
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Affiliation(s)
- Ismail Demiryilmaz
- General Surgery Department, Ibni Sina Hospital, Kayseri, Turkey
- Corresponding author: Ismail Demiryilmaz, General Surgery Department, Ibni Sina Hospital, Kayseri, Turkey. Tel.: +90-5324939415, Fax: +90-3522221076, E-mail:
| | - Ismayil Yilmaz
- Department of Surgery, Medical School, Erzincan University, Erzincan, Turkey
| | - Yavuz Albayrak
- General Surgery Department, Regional Education and Research Hospital, Erzurum, Turkey
| | - Kemal Peker
- Department of Surgery, Medical School, Erzincan University, Erzincan, Turkey
| | - Atalay Sahin
- Department of Thoracic Surgery, Medical School, Dicle University, Diyarbakir, Turkey
| | - Nurdan Sekban
- Anesthesiology and Critical Care Department, Ibni Sina Hospital, Kayseri, Turkey
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21
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Pahwa HS, Kumar A, Srivastava R. Laparoscopic cholecystectomy in situs inversus: points of technique. BMJ Case Rep 2012; 2012:bcr-2012-006170. [PMID: 22675150 DOI: 10.1136/bcr-2012-006170] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Laparoscopic cholecystectomy is one of the most common surgical procedures carried out in the world today. Rarely do patients present with undiagnosed situs inversus with cholecystitis. Symptomatic gallstones in patients with situs inversus pose diagnostic and therapeutic challenges. We had one such patient who presented with episodes of pain in the left upper abdomen. She was found to be suffering from situs inversus with gallstones in a left-sided gall bladder. After thorough preoperative evaluation, we performed laparoscopic cholecystectomy by modifying the operative technique adopting a mirror image of port placement on the left side using the left subcostal port (5 mm) for dissection with the right hand and the subxiphoid port for retraction of Hartmann's pouch by the left hand of the surgeon. We can summarise that laparoscopic cholecystectomy in patients of situs inversus can be safely performed by an experienced surgeon.
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Abstract
This reports suggests that single-incision laparoscopic cholecystectomy may be safely performed in patients with situs inversus totalis. Background and Objectives: Situs inversus totalis (SIT) is a rare congenital anomaly that can cause difficulties during standard laparoscopic cholecystectomy due to its mirror-image anatomy. These cases require more technically demanding procedures, and handedness of the surgeon may influence performance of these operations. Single-incision laparoscopic surgery (SILS) has been proposed as a less-invasive alternative to conventional laparoscopic surgery. We report the first case of successful SILS cholecystectomy in a patient with SIT and discuss technical aspects of the operation related to the handedness of the surgeon. Case: A 49-year-old man who was known to have situs inversus totalis presented with symptomatic cholelithiasis. This patient was operated on by a right-handed surgeon. The surgeon and camera assistant were positioned on the right and left side respectively with the video monitor above the patient's left shoulder. The SILS port (Covidien), which has 3 operating channels, was placed in the abdomen via a 2-cm intraumbilical incision. SILS cholecystectomy was performed successfully. Dissection of Calot's triangle and the gallbladder bed was performed using a dissector and hook in the right hand without any technical problems. Conclusion: SIT may confer an advantage over the orthotopic position for right-handed surgeons. SILS cholecystectomy can be performed safely in SIT.
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Affiliation(s)
- Mehmet Uludag
- Sisli Etfal Training and Research Hospital 2nd General Surgery, Sisli, Istanbul, Turkey; Atakent Mah. Manolya cikmazi No: 2E, D:1, Kucukcekmece, Istanbul, TURKEY (34303).
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23
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Ozsoy M, Haskaraca MF, Terzioglu A. Single incision laparoscopic cholecystectomy (SILS) for a patient with situs inversus totalis. BMJ Case Rep 2011; 2011:bcr.08.2011.4581. [PMID: 22679325 DOI: 10.1136/bcr.08.2011.4581] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Laparoscopic surgery has become the gold standard for the surgical treatment of benign disorders of bile ducts, for example, symptomatic cholelithiasis. Nowadays, laparoscopic surgery is becoming less invasive by means of the advanced technologic capabilities. In this article, the authors present a 65-year-old patient with situs inversus totalis who was examined because of abdominal pain and dyspeptic symptoms. Ultrasonography and tomography revealed cholecystitis with gallstones (calculous cholecystitis), besides, it was observed that the liver and the gall bladder were on the left side and the heart, the stomach and the spleen were located on the right side of the patient. The patient was performed single incision laparoscopic cholecystectomy. The patient was discharged on the postoperative day 1. In the present article, the authors described how easily the single incision laparoscopic cholecystectomy could resolve the technical difficulties encountered in the patients with situs inversus totalis during the conventional laparoscopic surgery.
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Affiliation(s)
- Mustafa Ozsoy
- Department of General Surgery, Manisa Merkezefendi State Hospital, Manisa, Turkey.
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24
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Single-incision multiport laparoscopic cholecystectomy for a patient with situs inversus totalis: report of a case. Surg Today 2011; 41:877-80. [PMID: 21626341 DOI: 10.1007/s00595-010-4387-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2009] [Accepted: 03/01/2010] [Indexed: 12/15/2022]
Abstract
Laparoscopic cholecystectomy has become the standard treatment for symptomatic cholelithiasis in patients with situs inversus totalis (SIT). Nowadays, single-incision multiport laparoscopic surgery is safe and feasible for treating benign gallbladder disease. We report a case of successful single-incision multiport laparoscopic cholecystectomy for a patient with SIT, and describe its technical advantages.
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25
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Laparoscopic cholecystectomy in situs inversus-our experience of 6 cases. Indian J Surg 2010; 72:391-4. [PMID: 21966139 DOI: 10.1007/s12262-010-0159-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2010] [Accepted: 04/19/2010] [Indexed: 10/18/2022] Open
Abstract
Laparoscopic cholecystectomy is the standard procedure for symptomatic gall stone disease. Situs inversus is a condition where the visceral anatomy is reversed. Laparoscopic cholecystectomy in a patient of situs inversus is a technically difficult procedure. Six patients of situs inversus underwent laparoscopic cholecystectomy from January 2003 to December 2009. In the first patient of situs inversus, we operated by placing the ports in mirror image fashion as that of standard laparoscopic cholecystectomy. However in next five patients we modified the technique by interchanging the epigastric and left mid clavicular line ports to overcome the problem of handedness. The procedure was successfully completed in all six patients. No intraoperative or postoperative complications occurred. The mean operating time was 65 mins (45-85 mins). Laparoscopic cholecystectomy is safe in patients of situs inversus. However, extreme care and skill is required to identify the reversed anatomy and to overcome the problem of handedness. Interchanging the epigastric and left mid clavicular line ports makes the procedure easier.
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26
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Hall TC, Barandiaran J, Perry EP. Laparoscopic cholecystectomy in situs inversus totalis: is it safe? Ann R Coll Surg Engl 2010; 92:W30-2. [PMID: 20529478 DOI: 10.1308/147870810x12699662980277] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Situs inversus totalis (SIT) is a rare defect of genetic predisposition. It may cause difficulties in the diagnostic and therapeutic management of abdominal pathology due to the mirror-image anatomy. We report the management of a case of symptomatic cholelithiasis with emphasis on its surgical technique combined with a review of the literature.
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Affiliation(s)
- T C Hall
- Department of Vascular Surgery, Scarborough General Hospital, Scarborough, UK.
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27
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Pataki I, Soultan TG, Chanis W. [Laparoscopic cholecystectomy in totalis situs inversus for cholecystitis]. Magy Seb 2010; 63:23-5. [PMID: 20156790 DOI: 10.1556/maseb.63.2010.1.4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Various congenital anomalies, organ transpositions impose special demands on building up the diagnosis; the mirror image of the abdominal organs tests the skills of the surgeon. We report a case of a 68 year old female patient, with a known situs inversus totalis, who underwent a laparoscopic cholecystectomy. We discuss our diagnostic steps (such as US, ERCP and EST), the variation of maneuvers used during the operation. No iatrogenic event occurred. We also stress that the surgeon should be alert of possible local anatomic variations and, if needed, conversion should be a solution of choice.
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Affiliation(s)
- István Pataki
- Magyar Imre Kórház, Sebészeti-szemészeti mátrix osztály, 8400 Ajka, Korányi F. u. 1.
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28
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Moo-Young TA, Picus DD, Teefey S, Strasberg SM. Common bile duct injury following laparoscopic cholecystectomy in the setting of sinistroposition of the galladder and biliary confluence: a case report. J Gastrointest Surg 2010; 14:166-70. [PMID: 19760370 DOI: 10.1007/s11605-009-0989-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2009] [Accepted: 08/10/2009] [Indexed: 01/31/2023]
Abstract
INTRODUCTION A bile duct injury occurred to a 64-year-old female with highly aberrant bile ducts due to sinistroposition. Methods of potential injury avoidance are discussed. MATERIALS AND METHODS A patient underwent elective laparoscopic cholecystectomy for symptomatic cholelithiasis. A left-sided gallbladder was diagnosed intraoperatively. Three days later, the patient presented with jaundice and rising liver function tests. The patient was referred to our institution for suspected bile duct injury. Endoscopic retrograde cholangiopancreatography showed complete occlusion of the common bile duct. A percutaneous transhepatic tube was placed in the bile ducts for decompression. During later operative exploration, a left-sided common hepatic duct was discovered. Review of preoperative imaging confirmed that the right hepatic duct crossed superior to the umbilical portion of the left portal vein and that segment 4 ducts drained into the right anterior sectional bile duct. CONCLUSION This case describes an extremely rare anomaly associated with an injury to the common bile duct during laparoscopic cholecystectomy. Knowledge of the complex and unusual alterations in biliary anatomy, which may accompany sinistroposition of the gallbladder, should aid in avoidance of such injuries in the future.
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Affiliation(s)
- Tricia A Moo-Young
- Section of HPB Surgery, Washington University in Saint Louis, Campus Box 8109, St. Louis, MO 63110, USA
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29
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Letters to the Editor. Am Surg 2009. [DOI: 10.1177/000313480907500416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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30
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Benjelloun EB, Zahid FE, Ousadden A, Mazaz K, Ait Taleb K. A case of gastric cancer associated to situs inversus totalis. CASES JOURNAL 2008; 1:391. [PMID: 19077286 PMCID: PMC2634770 DOI: 10.1186/1757-1626-1-391] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2008] [Accepted: 12/12/2008] [Indexed: 11/18/2022]
Abstract
The situs inversus is a rare congenital anomaly, which is a more or less complete inversion of the abdominal and thoracic organs. We report a case of 70 years old man, without pathological antecedents complaining about epigastric pains associated to haematemesis, and whose gastric endoscopy objectified a gastric tumor. The pulmonary x-ray and the abdominal computed tomography (CT) revealed the previously unrecognized situs inversus totalis. A subtotal gastrectomy was performed and patient had an uneventful postoperative course.
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31
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Faure JP, Doucet C, Scepi M, Rigoard P, Carretier M, Richer JP. Abnormalities of the gallbladder, clinical effects. Surg Radiol Anat 2008; 30:285-90. [PMID: 18330492 DOI: 10.1007/s00276-008-0332-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2007] [Accepted: 02/25/2008] [Indexed: 11/27/2022]
Abstract
The aim of this review of the literature was to present and discuss the anatomical and embryological basis of congenital abnormalities of the gallbladder, based on a case of volvulus. In the rare cases of ectopic gallbladder, diagnosis of a biliary disease could be difficult. In such cases surgery can also be dangerous, especially when it is associated with abnormalities of the intra-hepatic biliary and vascular tree. This study, based on the embryology of the extra hepatic bile duct, focused on the most frequent gallbladder abnormalities to keep them in mind.
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Affiliation(s)
- J P Faure
- Service Chirurgie Viscérale Digestive et Endocrinienne, Hôpital Jean Bernard, CHU Poitiers, Université de Poitiers, 2 rue de la Miletrie, BP 577, 86021 Poitiers Cedex, France.
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32
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Kumar S, Fusai G. Laparoscopic cholecystectomy in situs inversus totalis with left-sided gall bladder. Ann R Coll Surg Engl 2007; 89:W16-8. [PMID: 17346394 PMCID: PMC1964589 DOI: 10.1308/147870807x160461] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Symptomatic gallstones in patients with situs inversus pose diagnostic and therapeutic challenges. The presentation and management of one such patient is discussed with an emphasis on operative technique.
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Affiliation(s)
- Senthil Kumar
- Surgical Directorate, University College London Hospital, London, UK.
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33
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Aydin U, Unalp O, Yazici P, Gurcu B, Sozbilen M, Coker A. Laparoscopic cholecystectomy in a patient with situs inversus totalis. World J Gastroenterol 2006; 12:7717-9. [PMID: 17171807 PMCID: PMC4088060 DOI: 10.3748/wjg.v12.i47.7717] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Currently, laparoscopic cholecystectomy is an undoubtfully optimal treatment of cholelithiasis. What about performing this procedure on a patient with situs inversus totalis and what are the difficulties of this operation for a right-handed surgeon We presented a 35-year-old man with unknown situs inversus totalis who was admitted with epigastric pain and digestive problems. Ultrasonography and computed tomography of the abdomen confirmed the diagnosis of a gallstone. Besides, the liver and gallbladder were on the left side and the spleen was on the right. All systems were left-right reversal as mirror image in all diagnostic studies. Laparoscopic cholecystectomy was safely performed, despite of difficulties of situs inversus. The patient was discharged on postoperative day 1. It should be considered that existence of other anomalies may easily cause uninvited injuries. In the patients with situs inversus, laparoscopic cholecystectomy can be safely managed by an experienced surgeon through laparoscopy, and also hepatobiliary surgery.
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Affiliation(s)
- Unal Aydin
- Ege University School of Medicine, Bornova, Izmir 35100, Turkey.
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34
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Koo KP. Laparoscopic Nissen fundoplication in a patient with situs inversus totalis: an ergonomic consideration. J Laparoendosc Adv Surg Tech A 2006; 16:271-3. [PMID: 16796439 DOI: 10.1089/lap.2006.16.271] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
We report a laparoscopic Nissen fundoplication for gastroesophageal reflux disease in a patient with situs inversus totalis. The 65-year-old man was previously diagnosed with situs inversus totalis and presented with chronic gastroesophageal reflux disease inadequately controlled by medications. The laparoscopic procedure was performed with 5 ports placed in a mirror-image configuration and with the patient in the lithotomy position. Few technical difficulties were encountered during the operation. The position of the primary surgeon, working between the lower limbs of the patient, was considered critical to the success of this case. In situs inversus totalis, this position provides the least visual disorientation from the reversed abdominal organs. We recommend this position for all upper abdominal laparoscopic procedures in patients with situs inversus totalis, including laparoscopic cholecystectomy.
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Affiliation(s)
- Kenny P Koo
- Department of Surgery, Whidbey General Hospital, Coupeville, Washington, USA.
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35
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Bedioui H, Chebbi F, Ayadi S, Makni A, Fteriche F, Ksantini R, Jouini M, Kacem M, Ben Safta Z. [Laparoscopic cholecystectomy in a patient with situs inversus]. ACTA ACUST UNITED AC 2006; 131:398-400. [PMID: 16460662 DOI: 10.1016/j.anchir.2005.12.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2005] [Accepted: 12/19/2005] [Indexed: 11/19/2022]
Abstract
Laparoscopic cholecystectomy is the standard approach to manage symptomatic gallbladder stones. However, only twelve patients with total situs invertus have been previously reported in the literature. We report a new case of a 58-year-old patient hospitalized for acute pain of the left hypochondrium with fever. The diagnosis of acute cholecystitis with situs inversus totalis was made following clinical examination and radiological investigations. Laparoscopic cholecystectomy was subsequently performed through a modification of the technique to adapt to the mirror image anatomy.
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Affiliation(s)
- H Bedioui
- Service de Chirurgie A, Hôpital La-Rabta, 1007 Jabbari, Tunis, Tunisie.
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36
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McKay D, Blake G. Laparoscopic cholecystectomy in situs inversus totalis: a case report. BMC Surg 2005; 5:5. [PMID: 15774004 PMCID: PMC555757 DOI: 10.1186/1471-2482-5-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2004] [Accepted: 03/17/2005] [Indexed: 01/11/2023] Open
Abstract
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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Affiliation(s)
- Damian McKay
- The Department of Surgery, Daisy Hill Hospital, 5 Hospital Road, Newry, Co Down, BT35 8DR
Northern Ireland
| | - Geoffrey Blake
- The Department of Surgery, Daisy Hill Hospital, 5 Hospital Road, Newry, Co Down, BT35 8DR
Northern Ireland
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37
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Kang SB, Han HS. Laparoscopic exploration of the common bile duct in a patient with situs inversus totalis. J Laparoendosc Adv Surg Tech A 2004; 14:103-6. [PMID: 15107220 DOI: 10.1089/109264204322973880] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Situs inversus totalis (SIT) is a rare anomaly that can present technical difficulties during laparoscopic surgery. We report the first case of a combination of SIT and choledocholithiasis in a patient who was treated successfully with a laparoscopic exploration of the common bile duct (CBD). The chest x-ray showed a right-sided heart. An abdominal ultrasound and computerized tomography scan diagnosed the CBD and gallbladder stones as well as the SIT, with the liver and gallbladder on the left side, and the spleen on the right. The surgical techniques were modified in a mirror image fashion in order to provide access to the left upper quadrant. The surgeon and the camera assistant stood on the patient's right side, and the first assistant stood on the left. The ports were introduced in a mirror image of the conventional setup. The SIT was confirmed using a telescope via an umbilical incision. A laparoscopic exploration of the CBD with a cholecystectomy was carried out successfully. The postoperative course was uneventful. This report shows that a CBD stone in a patient with SIT can be treated safely using laparoscopic surgery.
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Affiliation(s)
- Sung-Bum Kang
- Department of Surgery, Seoul National University, Bundang Hospital, Seoul, Korea
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Kobus C, Targarona EM, Bendahan GE, Alonso V, Balagué C, Vela S, Garriga J, Trias M. Laparoscopic surgery in situs inversus: a literature review and a report of laparoscopic sigmoidectomy for diverticulitis in situs inversus. Langenbecks Arch Surg 2004; 389:396-9. [PMID: 15243744 DOI: 10.1007/s00423-004-0500-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2003] [Accepted: 05/14/2004] [Indexed: 12/15/2022]
Abstract
BACKGROUND Situs inversus (SI) is a rare autosomal recessive congenital defect in which the position of abdominal and/or thoracic organs is a "mirror image" of the normal one, in the sagittal plain. In 25% of these cases, SI is part of the Kartagener syndrome, together with bronchiectasis and chronic sinusitis. METHODS We present a case of a patient with Kartagener syndrome and complete SI that was laparoscopically operated on for diverticulitis. We also review the published English information available on this rare condition. RESULTS A review of the literature revealed another single case of laparoscopic sigmoidectomy and 27 cases of other laparoscopic interventions in the presence of SI. Those laparoscopic procedures included basic procedures such as explorations and cholecystectomies, as well as advanced procedures such as gastrectomy and gastric bypass. CONCLUSION The laparoscopic approach is feasible in cases of SI, although technically more complicated because of the different position of the organs and the different laparoscopic view of the anatomy.
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Affiliation(s)
- Christian Kobus
- Servei de Cirurgia, Hospital de Sant Pau, P Claret 167, 08025 Barcelona, Spain
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Yaghan R, Heis H, Bani-Hani K, Matalka I, Shatanawi N, Gharaibeh K, Bani-Hani A. Is fear of anaphylactic shock discouraging surgeons from more widely adopting percutaneous and laparoscopic techniques in the treatment of liver hydatid cyst? Am J Surg 2004; 187:533-7. [PMID: 15041506 DOI: 10.1016/j.amjsurg.2003.12.046] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2003] [Revised: 10/31/2003] [Indexed: 11/19/2022]
Abstract
BACKGROUND Sources of reports about laparoscopic and percutaneous treatment of liver hydatid cysts are limited to just a few countries. To address the reason behind this, we carried out a survey of 30 surgeons in northern Jordan. METHODS A questionnaire was distributed to collect data regarding the surgical technique preferred by each surgeon. Further information was collected from those not adopting minimal-access techniques to determine their reasons for not doing so. RESULTS Only 3 surgeons (10%) considered laparoscopy as the first line of treatment. Of the 27 surgeons who did not consider percutaneous or laparoscopic treatment, fear of anaphylaxis and/or dissemination was the main reason given by 21 surgeons (78%) for not using minimal access techniques. CONCLUSIONS The seemingly exaggerated traditional fear of anaphylaxis seems to discourage surgeons from more widely adopting minimal access techniques for the treatment of hydatid cyst.
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Affiliation(s)
- Rami Yaghan
- Department of Surgery, Jordan University of Science and Technology, P.O. Box 3030, Irbid, Jordan.
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Kobus C, Targarona EM, Alonso V, Moya I, Even Bendahan G, Cherichetti C, Balagué C, Vela S, Garriga J, Trias M. Cirugía laparoscópica y situs inversus. Revisión de la literatura y presentación de un caso de sigmoidectomía por diverticulitis. Cir Esp 2003. [DOI: 10.1016/s0009-739x(03)72166-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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