scholarly journals Laparoscopic Cholecystectomy in Situs Inversus, a Novel Port Placement Technique, Two Case Reports, and Review of Literature

2021 ◽  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Situs Inversus ◽  
Epigastric Pain ◽  
Case Reports ◽  
Abdominal Ultrasound ◽  
Situs Inversus Totalis ◽  
Port Placement ◽  
Technical Problems ◽  
Anatomical Changes ◽  
Gallbladder Diseases

Background: Situs Inversus Totalis (SIT) is a rare and silent autosomal recessive disease in which all organs are on the opposite side. Diagnosis of gallbladder diseases will be difficult due to these anatomical changes. Laparoscopic cholecystectomy is the standard treatment for gallbladder diseases but is technically challenging for patients. Case presentation: Two 52- and 64-year-old women with known SIT who complained of intermittent epigastric pain and nausea after eating fatty and bulky meals were examined. With the help of abdominal ultrasound, a gallbladder on the left side of the abdomen with multiple gallstones was shown. Conclusion: Since the successful primary cholecystectomy was performed on a patient with SIT in 1991, several modifications have been made for port insertion. Surgeons try to overcome technical problems by making various adjustments compared to conventional laparoscopic cholecystectomy. Laparoscopic cholecystectomy in patients with SIT is safe. However, laparoscopic cholecystectomy is challenging due to anatomical changes in the SIT. Our proposed method of port placement helps right-handed surgeons for safer and easier dissection.

Case Report of Situs Inversus Totalis and Laparoscopic Cholecystectomy

2016 ◽  
Vol 101 (7-8) ◽  
pp. 347-351 ◽  
Author(s):  
Thomas K. Duncan ◽  
Kenneth Waxman
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Situs Inversus ◽  
Epigastric Pain ◽  
Signs And Symptoms ◽  
Technical Difficulty ◽  
Situs Inversus Totalis ◽  
Mirror Image ◽  
The Body ◽  
Critical View Of Safety ◽  
The Right

Laparoscopic cholecystectomy (LC) in patients with situs inversus totalis (SIT) characterized by transposition of organs to the opposite side of the body can be technically challenging. A 43-year-old Hispanic woman presented with epigastric pain radiating to the chest and back, intermittently over 3 months, but worse on day of admission. During the cardiac workup, she was noted to have dextrocardia. The patient had a left-sided Murphy's sign, propagating a workup that confirmed SIT, including an ultrasound showing cholelithiasis and normal ducts. The patient underwent an LC and was found to have choledocholithiasis. An endoscopic retrograde cholangiopancreatography cleared the common bile duct of a choledocholith. LC is the gold standard for cholecystitis. It is the second most common laparoscopic procedure conducted worldwide. When SIT is encountered, feasibility and technical difficulty in diagnosis and treatment of such cases pose challenges due to contralateral transposition of the visceral organs. Difficulty is encountered when exposing the triangle of Calot/critical view of safety and especially when conducting a cholangiogram. As such, added time is usually required to conduct the procedure. Conducting an LC in a patient with SIT is feasible when performed by an experienced laparoscopic surgeon. The diagnosis and initial presenting signs and symptoms are different from the patient with a normal anatomy. The surgical skills of the surgeon are challenged, especially in the right hand–dominant individual. The mindset of the surgeon requires changing the critical thinking when conducting a mirror image dissection.

scholarly journals LAPAROSCOPIC CHOLECYSTECTOMY IN SITUS INVERSUS TOTALIS: CASE REPORTS WITH REVIEW OF LITERATURE

2019 ◽  
Vol 3 (9) ◽  
Author(s):  
Bhupander Kumar Chawla ◽  
Aditya Chawla
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Situs Inversus ◽  
Case Reports ◽  
Situs Inversus Totalis ◽  
Cystic Artery ◽  
The Body ◽  
Review Of Literature ◽  
Additional Time ◽  
Rare Congenital Anomaly ◽  
Calot’S Triangle

The first-ever known case of situs inversus in humans was reported by Fabricius in 1600[i]. The possible incidence in the region is approximated between 1:5000 and 1:200001. It can either be partial, in which the transposition gets confined to abdominal/thoracic viscera, or it may be complete, which includes both the cavities[ii]. Characterized by transposition of organs to the opposite side of the body, Situs inversus totalis is a rare congenital anomaly. Due to atypical clinical picture and due to the contralateral disposition of the visceral organs in such cases of cholelithiasis, the diagnosis, as well as the treatment, becomes a tough task for the surgeon. In such patients laparoscopic cholecystectomy is undoubtedly more demanding. Even though it is more feasible but only trained and experiences laparoscopic surgeons must perform laparoscopic cholecystectomy. The skeletonizing of the cystic duct and cystic artery in Calot's triangle is a difficult task where additional time than the normal is required for locating the gall bladder. Keywords: Cholelithiasis, laparoscopic cholecystectomy, situs inversus totalis

scholarly journals Laparoscopic Cholecystectomy in Kartagener Syndrome

2017 ◽  
Vol 51 (4) ◽  
pp. 192-194
Author(s):  
Rahul Gupta ◽  
Harjeet Singh ◽  
Ganga R Verma
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Laparoscopic Surgery ◽  
Magnetic Resonance ◽  
Situs Inversus ◽  
Autosomal Recessive ◽  
Epigastric Pain ◽  
Autosomal Recessive Disorder ◽  
Situs Inversus Totalis ◽  
Kartagener Syndrome ◽  
Abdominal Organs

ABSTRACT Kartagener syndrome is a rare autosomal recessive disorder in which there is situs inversus involving abdominal or thoracic viscera or both. Anatomy of the abdominal organs in such a patient is distorted making laparoscopic surgery very difficult. A 45-year-old lady, a known case of Kartagener syndrome, presented with epigastric pain. Ultrasound of abdomen revealed situs inversus with mild hepatomegaly and multiple gallbladder calculi. Magnetic resonance pancreatocholangiography (MRCP) confirmed situs inversus totalis with cholelithiasis and mild central intrahepatic biliary dilatation. Patient was treated successfully with laparoscopic cholecystectomy. How to cite this article Gupta R, Singh H, Verma GR. Laparoscopic Cholecystectomy in Kartagener Syndrome. J Postgrad Med Edu Res 2017;51(4):192-194.

scholarly journals Laparoscopic cholecystectomy in situs inversus totalis: A case report

2021 ◽  
Vol 38 (2) ◽  
pp. 183-188
Author(s):  
Radomir Gelevski ◽  
Gjorgji Jota ◽  
Lazar Todorović ◽  
Gjorgji Trajkovski ◽  
Vladimir Joksimović ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Situs Inversus ◽  
Epigastric Pain ◽  
Genetic Defect ◽  
Operating Time ◽  
Situs Inversus Totalis ◽  
Mirror Image ◽  
Digestive Tube ◽  
Left Hand ◽  
Standard Position

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.

scholarly journals Laparoscopic Cholecystectomy in a Patient with Situs Inversus Totalis: Port Placement and Dissection Techniques

2020 ◽  
Vol 21 ◽  
Author(s):  
Tianli Du ◽  
Abdelkader Hawasli ◽  
Karen Summe ◽  
Ahmed A. Meguid ◽  
Christopher Lai ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Situs Inversus ◽  
Situs Inversus Totalis ◽  
Port Placement ◽  
Dissection Techniques

Laparoscopic cholecystectomy in a patient with situs inversus totalis

2020 ◽  
Vol 8 (3) ◽  
pp. 145
Author(s):  
Abeer Aljahdali ◽  
Saad Almowallad ◽  
Tariq Habib
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Situs Inversus ◽  
Situs Inversus Totalis
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