LAPAROSCOPIC STUDY OF CHOLECYSTECTOMY IN SITUS INVERSUS TOTALIS

2021 ◽  
pp. 67-69
Author(s):  
Rajeev Ranjan ◽  
Kamlesh Kumar Sahu ◽  
V.S. Prasad
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Gall Bladder ◽  
Situs Inversus Totalis ◽  
Mirror Image ◽  
The Body ◽  
Medical College ◽  
Left Hypochondrium ◽  
Atypical Clinical Presentation ◽  
Feasible Option ◽  
Elective Laparoscopic Cholecystectomy

BACKGROUND: Situs inverses totalis is a rare congenital anomaly with transposition of major organs to opposite side of the body. Due to atypical clinical presentation and due to contra lateral presence of the gall bladder, it causes clinical challenge to operate with complete reorientation of anatomy. Visual motor skills are particularly tested when it comes to lapararoscopy. MATERIAL AND METHODS: A 25 year, lady presented with left hypochondriac pain and diagnosed as calculus cholecystitis with situs inverses total is. After ruling out associated anamolies patient underwent elective laparoscopic cholecystectomy. Around 60 cases of situs inverses total is with cholecystectomy have been reported till date. These cases cause technical and visuo-motor difculty due to contra lateral deposition of gall bladder in left hypochondrium during laparoscopic cholecystectomy. Consumption of extra time also been reported during calot's dissection, as it's like operating on a mirror image, Department of General surgery Darbhanga medical college and Hospital Laheriasarai Darbhanga Bihar. CONCLUSION: Laparoscopic cholecystectomy, the gold standard treatment for cholelithiasis, is a feasible option even in cases with SIT; in the hands of good experienced, ambidextrous laparoscopic surgeons

scholarly journals LAPAROSCOPIC CHOLECYSTECTOMY IN SITUS INVERSUS TOTALIS – A CASE REPORT

2019 ◽  
Vol 3 (10) ◽  
Author(s):  
Dr Rohit Phadnis ◽  
Dr. U Sowmya
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Gall Bladder ◽  
Situs Inversus Totalis ◽  
Mirror Image ◽  
The Body ◽  
Left Hypochondrium ◽  
Atypical Clinical Presentation ◽  
Feasible Option ◽  
Elective Laparoscopic Cholecystectomy ◽  
Hypochondriac Pain

Background: Situs inverses totalis is a rare congenital anomaly with transposition of major organs to opposite side of the body. Due to atypical clinical presentation and due to contra lateral presence of the gall bladder, it causes clinical challenge to operate with complete reorientation of anatomy. Visual motor skills are particularly tested when it comes to lapararoscopy.  Case: A 25 year, lady presented with left hypochondriac pain and diagnosed as calculus cholecystitis with situs inverses total is. After ruling out associated anamolies patient underwent elective laparoscopic cholecystectomy.  Discussion: Around 60 cases of situs inverses total is with cholecystectomy have been reported till date. These cases cause technical and visuo-motor difficulty due to contra lateral deposition of gall bladder in left hypochondrium during laparoscopic cholecystectomy. Consumption of extra time also been reported during calot’s dissection, as it’s like operating on a mirror image.  Conclusion: Laparoscopic cholecystectomy, the gold standard treatment for cholelithiasis, is a feasible option even in cases with SIT; in the hands of good experienced, ambidextrous laparoscopic surgeons.

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.

Frequency of port site infection following gall bladder removal through Epigastric vs Umbilical port.

2021 ◽  
Vol 28 (03) ◽  
pp. 277-281
Author(s):  
Bushra Shaikh ◽  
Imamuddin Baloch ◽  
Azhar Ali Shah ◽  
Abdul Sami Mirani ◽  
Parkash Lal Lund ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Gall Bladder ◽  
Wound Infection ◽  
Port Site ◽  
Site Infection ◽  
College Hospital ◽  
Medical College ◽  
Duration Of Surgery ◽  
Group A ◽  
Group B

Objective: To compare the frequency of port site wound infection following gall bladder removal through umbilical and epigastric port in laparoscopic cholecystectomy. Study Design: Randomized Control Trial. Setting: Surgical Unit 2, Ghulam Muhammad Mahar Medical College, hospital Sukkur. Period: 1st November 2019 to 30th October 2020. Material & Methods: All cases who underwent four port laparoscopic cholecystectomy were enrolled in two groups. All procedures were performed under general anesthesia. As the last event of surgery gall bladder was retrieved in a glove bag through umbilical port in group A and through epigastric port in group B, both under direct camera vision. Wound infection was considered if there was 3 to 5 grade of wound according to Southampton wound grading system (Figure-1) on 5th postoperative day. All demographics and outcome variables were recorded. Results: Age ranged from 20 to 60 years with mean age of 38.875±8.11 years, BMI 29.973±5.12 Kg/m2, duration of surgery 50.656±8.41 mins and Southampton score was 1.044±1.07 in Group A and mean age of 38.560±6.23 years, BMI 27.437±5.04 Kg/m2, duration of surgery 48.920±8.67 mins and Southampton score was 0.856±0.92 in Group B. In group A, 18 (5.7%)patients developed port site wound infection in contrast to 5 (1.6%) patients in group B (P= 0.006). Conclusion: We conclude that epigastric port retrieval of gall bladder following laparoscopic cholecystectomy results in less port site infection.

Situs Inversus Totalis

2001 ◽  
Vol 20 (1) ◽  
pp. 63-67 ◽  
Author(s):  
Janie Spoon
Keyword(s):  
Situs Inversus ◽  
Vena Cava ◽  
Situs Inversus Totalis ◽  
Mirror Image ◽  
The Body ◽  
Radiographic Examination ◽  
Internal Organs ◽  
Radiographic Findings ◽  
Situs Solitus ◽  
The Right

EXTERNALLY, THE HUMAN BODY appears symmetric; if a line is drawn down the middle of the body, each side appears identical. However, this is not true of the internal anatomy. For example, there is one heart, which lies in the left chest, one liver, in the right abdomen, and one stomach, in the left abdomen. The term situs refers to the position or location of an organ, specifically, the position of the atria and abdominal viscera in relation to the midline of the body.1 There are three types of situs: solitus, inversus, and ambiguous. Situs solitus refers to the normal arrangement of organs, with the right atrium, liver, gallbladder, trilobed lung, and inferior vena cava on the right side and the left atrium, stomach, spleen, bilobed lung, and descending aorta on the left side (Figures 1–3). Situs inversus totalis refers to a mirror image reversal of the normal position of the internal organs (Figures 4 and 5). 1 The incidence of situs inversus totalis is 1 in every 8,000 to 25,000 births, and the condition is most often diagnosed by radiographic examination.2Situs ambiguous, often referred to as heterotaxia, is the random arrangement of the internal organs and is associated with splenic abnormalities and congenital heart disease.3 The purpose of this column is to discuss the embryology, pathophysiology, and diagnosis of situs inversus totalis and to review a case study with radiographic findings.

Gall-Bladder Duplication - Case Report

2014 ◽  
Vol 86 (9) ◽  
Author(s):  
Bogusław Koszman
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Case Report ◽  
Gall Bladder ◽  
Anatomical Variation ◽  
Ultrasound Scanning ◽  
Persistent Symptoms ◽  
Bladder Duplication ◽  
Elective Laparoscopic Cholecystectomy ◽  
Safe Performance

AbstractGall-bladder duplication is a rare anatomical variation, which can affect safe performance of cholecystectomy and be a cause of persistent symptoms and a need for reoperation in case of accessory gall-bladder omission.A case of successfully performed elective laparoscopic cholecystectomy in a patient with duplicated gall-bladder accidentally intraoperatively disclosed is presented.The identified anomaly was classified according to the Harlaftis Classification of Multiple Gall-bladders. Attention was drawn to the uneffectivenes of ultrasound scanning in multiple gall-bladders preoperative detecting, and presence of other non-biliary anatomical variation in the same individual as well.

scholarly journals Laparoscopic Cholecystectomy in a patient with Situs Inversus Totalis

2021 ◽  
Vol 9 (1) ◽  
pp. 43-45
Author(s):  
Samail Shahjahan ◽  
Anisur Rahman
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Gall Bladder ◽  
Situs Inversus ◽  
Gall Bladder Disease ◽  
Situs Inversus Totalis ◽  
Conventional Laparoscopic Cholecystectomy ◽  
Conventional Laparoscopic ◽  
Bladder Disease ◽  
Complete Reversal ◽  
Technical Details

There are diagnostic and therapeutic challenges in cases of symptomatic gall bladder disease in patients with situs inversus totalis (SIT), where there is complete reversal of visceral topography in thorax, abdomen or both. The difficulty to treat these patients with conventional laparoscopic cholecystectomy may be more pronounced for right handed surgeon and requires modifications in working ports and their positions. We present a case of laparoscopic cholecystectomy in a patient with SIT, and describe the technical details that enable the safe conclusion of the operation. Bangladesh Crit Care J March 2021; 9(1): 43-45

scholarly journals Cholecystitis in Situs Inversus with Dextrocardia

2018 ◽  
Vol 3 (2) ◽  
pp. 87
Author(s):  
Mohammad Ali Raza Qizalbash ◽  
Rida Zahra ◽  
Adnan Adil Mithwani ◽  
Anwar Adil Mithwani ◽  
Muaaz Adil Mithwani ◽  
...  
Keyword(s):  
Congenital Anomaly ◽  
Emergency Department ◽  
Case Report ◽  
Acute Cholecystitis ◽  
Situs Inversus ◽  
Open Cholecystectomy ◽  
Situs Inversus Totalis ◽  
The Body ◽  
Rare Congenital Anomaly ◽  
Left Hypochondrium

Background: Surgical problem known as Acute Cholecystitis is very common nowadays; however it may cause trouble in diagnosing when person has situs inversus, (i.e.) viscera situated on the opposite side of the body. Our case report discusses the history and physical exam findings, images of radiograph, diagnosis, and how we dealt with cholecystitis in situs inversus with dextrocardia.Case Presentation: An eighty-six yrs. old male having pain in the upper left hypochondrium region, presented in emergency department. He was later diagnosed to have acute cholecystitis (inflammation of the gallbladder) with cholelithiasis (presence of gallstones in gallbladder) in situs inversus totalis. Patient underwent elective open cholecystectomy within 24 h. Patient recovered well and was discharged on fourth postoperative day.Conclusion: Acute cholecystitis in Situs Inversus with Dextrocardia is very rare congenital anomaly and requires great expertise in the field of surgery to operate on these patients because of the reverse anatomy of the organs.

scholarly journals THE EFFECT OF HIGH DOSE AND LOW DOSE PREGABALIN AS PREMEDICATION ON PREOPERATIVE ANXIETY AND SEDATION LEVELS

2021 ◽  
Vol 71 (5) ◽  
pp. 1759-63
Author(s):  
Ayman Zafar ◽  
Kulsoom Farhat ◽  
Mobasher Ahmed Saeed ◽  
Waqar Aslam Khan ◽  
Shabana Ali ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
General Anesthesia ◽  
Preoperative Anxiety ◽  
High Dose ◽  
Medical College ◽  
Preoperative Administration ◽  
Elective Laparoscopic Cholecystectomy ◽  
Group 3 ◽  
The Difference ◽  
Group 2

Objective: To assess the role of pregabalin as premedication for preoperative sedation & anxiolysis with two different doses in laparoscopic cholecystectomy patients. Study Design: Prospective, randomized control study Place and Duration of Study: Department of Pharmacology and Therapeutics, Army Medical College, Rawalpindi in collaboration with Department of Anesthesiology, CMH, Rawalpindi from February 2019 to July 2019. Patients & Methods: 96 patients of either gender, aged between 18 to 60 years with ASA grade I-II, undergoing elective laparoscopic cholecystectomy were enrolled in this study. They were randomly divided into three groups having 32 patients each. Group 1 received oral placebo drug, Group 2 received oral pregabalin 150 mg, whereas Group 3 received oral pregabalin 300mg with sip of water 90 mins before the induction of general anesthesia. The effects of drugs on the patient’s level of sedation and anxiety were evaluated at baseline and before the induction of anesthesia using Ramsay Sedation Score and Beck Anxiety Inventory respectively. Results: Premedication with pregabalin 150mg and 300mg significantly produced sedation as compared to placebo. Though, pregabalin 300mg exhibited more sedation than pregabalin 150mg but the difference between them was statistically insignificant (p >0.05). Preoperative administration of pregabalin was related with anxiolysis, with the most prominent results shown by pregabalin 300mg (p <0.05) whereas pregabalin 150mg couldn’t alleviate anxiety and the results were statistically insignificant (p >0.05). Conclusions: Premedication with pregabalin 300mg, 90 mins before the induction of general anesthesia is an effective regimen to alleviate preoperative anxiety and sedation.

COMPARISON OF EFFECTIVENESS AMONG ONDANSETRON, PALONOSETRON AND GRANISETRON IN PREVENTING POSTOPERATIVE NAUSEAAND VOMITING FOLLOWING LAPAROSCOPIC CHOLECYSTECTOMY

2021 ◽  
pp. 65-67
Author(s):  
Amrit Ghosh ◽  
Arabinda Mazumdar ◽  
Sujan Sarkar ◽  
Ashim Mandal ◽  
Debarshi Jana
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Postoperative Nausea ◽  
Postoperative Nausea And Vomiting ◽  
Nausea And Vomiting ◽  
Postoperative Vomiting ◽  
Medical College ◽  
Effective Prophylaxis ◽  
Elective Laparoscopic Cholecystectomy ◽  
Comparison Of Effectiveness ◽  
Double Blinded

Postoperative nausea and vomiting (PONV) has been variously described as the “big little problem” the “nal therapeutic challenge” for anaesthesiology. The commonest cause of morbidity after anaesthesia and surgery are pain and postoperative nausea vomiting 1. To compare the incidences of PONV following laparoscopic cholecyetectomy in different groups of patients receiving ondansetron, palonosetron and Granisetron. 2. To identify the better strategy for prevention of PONV. This is a prospective randomized double blinded clinical study. Both patient and observer were blinded to the group allocation. Allocations to three groups were strictly condential and concealed. One and half year (18 months). Patients undergoing elective laparoscopic cholecystectomy under General Anaesthesia at General Surgery operation theatres of Bankura Sammilani Medical College and Hospital, Bankura The effects of palonosetron, granisetron and ondansetron in preventing PONV (postoperative nausea vomiting) were compared in patients undergoing laparoscopic cholecystectomy and it was found that palonosetron was best and granisetron better in comparison with ondansetron in preventing postoperative nausea and vomiting. Palonosetron provides more effective prophylaxis of early PON (postoperative nausea), late PON (postoperative nausea), and late POV (postoperative vomiting) compared with granisetron and ondansetron. Palonosetron could provide effective prophylactic antiemetic control to prevent PONVafter laparoscopic cholecystectomy surgery under general anesthesia.

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