Page 20 - World Journal of Laparoscopic Surgery

ORIGINAL ARTICLE
Our Experience of Laparoscopic Cholecystectomy in Situs

Inversus Totalis

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MR Attri , Rajni , Abdul H Samoon , Irshad A Kumar 4
AbstrAct
Introduction: First laparoscopic cholecystectomy in situs inversus totalis (SIT) patients was described by Campos and Sipes. We present a
retrospective study of five cases in whom laparoscopic cholecystectomy was done for symptomatic cholelithiasis.
Methodology: This is a retrospective study from 2005 to 2021. All the patients in the study were done by a single surgeon at various hospitals
in the state. All recorded data from patients and from hospitals was taken and analyzed.
Results: Our study included five patients with the mean age of 31.6 years. All the patients were females. Our patients presented with complaints
of epigastric pain (2), dyspepsia (1), and pain in the left upper abdomen (2). There was no associated cardiac anomaly in our patients. The
first three patients were operated on using conventional mirror image technique, the fourth one by modified mirror image, and the last one
using French technique. In initial cases operating time was 45–50 minutes which decreased up to 35–40 minutes in the last cases. All patients
were discharged on the first postoperative day after tolerating orals and with the satisfactory condition on discharge. There was no intra- or
postoperative complication in our study. There was no 30-day mortality in our patients.
Conclusion: SIT is a rare congenital anomaly. A laparoscopic cholecystectomy is a safe approach with meticulous dissection in these patients
with cholelithiasis. Technical difficulties could be overcome due to learning and better understatement of ergonomics of these patients.
Keywords: Laparoscopic cholecystectomy, Mirror image, Situs inversus.
World Journal of Laparoscopic Surgery (2022): 10.5005/jp-journals-10033-1495

IntroductIon 1,3,4 Department of Surgery, Government Medical College, Srinagar,
Situs inversus is a rare recessive congenital anomaly with an Jammu and Kashmir, India
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incidence of 1:10,000–1:20,000. Fabricius first reported situs 2 Department of Surgery, Government Medical College, Jammu,
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inversus totalis (SIT) in 1,600. Genetically it shows an autosomal Jammu and Kashmir, India
recessive pattern and the genetic defect occurs in 2nd week of Corresponding Author: Irshad A Kumar, Department of Surgery,
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embryonic life. In SIT, the transposition of organs is opposite Government Medical College, Srinagar, Jammu and Kashmir, India,
to their normal position and hence gallbladder is present in the Phone: +91 07006122289, e-mail: irshadahmadkumar@gmail.com
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left hypochondrium instead of right hypochondrium. Cardiac How to cite this article: Attri MR, Rajni, Samoon AH, et al. Our
anomalies and a triad known as Kartagener Triad (Bronchiectasis, Experience of Laparoscopic Cholecystectomy in Situs Inversus Totalis.
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Sinusitis, Situs inversus) have been associated with this condition. World J Lap Surg 2022;15(1):18–20.
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Male and female gender have equal incidence. In literature no
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higher association is reported with cholelithiasis. Laparoscopic Source of support: Nil
cholecystectomy since its introduction in 1987 has revolutionized Conflict of interest: None
the world and has set new principles of minimal invasiveness in the
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surgical field. Laparoscopic cholecystectomy is widely accepted
as the treatment of choice for cholelithiasis in SIT patients despite X-ray, which showed cholelithiasis and confirmed patients of SIT.
the difficulties in the orientation and the ergonomics of the Magnetic resonance cholangiopancreatography (MRCP) was done
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surgical field. First laparoscopic cholecystectomy in SIT patients to confirm cholelithiasis and to rule out any other biliary anomaly.
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was described by Campos and Sipes. Since then more than 90 ECHO cardiography was done to rule out any cardiac anomaly. After
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cases have been described. We present a retrospective study of all necessary investigations’ patients were listed in elective lists for
five cases in whom laparoscopic cholecystectomy was done for laparoscopic cholecystectomy.
symptomatic cholelithiasis. The patients were operated using mirror image technique,
modified mirror image, and French technique for laparoscopic
cholecystectomy. In the mirror image technique all instruments,
Methodology surgeons, assistants, and ports were the mirror image of
This is a retrospective study from 2005 to 2021. All of the patients the conventional laparoscopic cholecystectomy. While in
in the study were done by a single surgeon at various hospitals modified mirror image technique 10-mm port was used at the
of the state. All recorded data from patients and from hospitals midclavicular line as the main working port and for gall bladder
was taken and analyzed. All patients with SIT with laparoscopic removal. While a 5-mm port was used at the epigastric point. In
cholecystectomy done by the single surgeon were included. A the French technique, the difference with the modified mirror
total of five patients were included in the study. All our patients image technique was the placement of the surgeon in between
were evaluated by baseline blood tests, ultrasonography, and chest legs instead of the right side of the patient. Calot’s triangle was
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