Page 21 - World Journal of Laparoscopic Surgery

Laparoscopic Cholecystectomy in Situs Inversus Totalis

Fig. 1: Showing gallbladder dissection from the liver bed

Table 1: Descriptive data of patients
Sl. No. Age (years) Gender Comorbidity Operative technique Year Postoperative complication
1 45 Female Hypothyroid, hypertension Conventional mirror image 2005 Nil
2 34 Female Nil Conventional mirror image 2006 Nil
3 33 Female Nil Conventional mirror image 2011 Nil
4 32 Female Nil Modified mirror image 2012 Nil
5 14 Female Nil French 2021 Nil
delineated and cholecystectomy was done using the duct first The first laparoscopic cholecystectomy in SIT patients was
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method (Fig. 1). The gallbladder was retrieved either through the performed by Campos and Sipes. Since then, more than 90 cases
epigastric or midclavicular port. All recorded data was analyzed have been reported in the literature and none has mentioned any
and results were interpreted. complication despite the difficulty in ergonomics in SIT patients.
However multiple techniques have been put forward in order
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to ease the biliary dissection. In our study we used multiple
results techniques like a conventional mirror image, modified mirror image,
Our study included five patients with the mean age of 31.6 years and French technique. In neither case, any complication occurred
(14–45 years). As shown in Table 1. All the patients were females. despite dissection difficulty in mirror image, nor was any case
Our patients presented with complaints of epigastric pain (2), converted to open. The meticulous dissection is the only option
dyspepsia (1), and pain in the left upper abdomen (2). There was no of safety in this group of people. Our study had similar results as
associated cardiac anomaly in our patients. Only a single patient was other case reports, studies or, reviews done earlier. 10,15
hypothyroid and had hypertension, and was on optimum treatment.
The first three patients were operated using the conventional
mirror image technique, the fourth one by modified mirror image conclusIon
and the last one using French technique. In initial cases, operating SIT is a rare congenital anomaly. A laparoscopic cholecystectomy
time was 45–50 minutes which decreased up to 35–40 minutes in is a safe approach with meticulous dissection in these patients
the last cases. This decrease in operating time was due to a better with cholelithiasis. Technical difficulties could be overcome due
understanding of operative ergonomics in SIT patients. All patients to learning and better understatement of ergonomics of these
were discharged on the first postoperative day after tolerating patients.
orals and with the satisfactory condition on discharge. There was
no intra- or postoperative complication in our study. There was no orcId
30-day mortality in our patients.
Irshad A Kumar https://orcid.org/0000-0002-6451-5535

dIscussIon references
SIT is a rare congenital anomaly with a global prevalence of 1. Ahmed Z, Khan S, Chhabra S, et al. Our experience with surgery
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about 0.01%. The characteristics of SIT is that all the organs of in situs inversus: Open peptic perforation repair and laparoscopic
the body have an exact mirror image position than their normal cholecystectomy in 1 patient and 3 patients respectively. Int J Surg
counterparts. 12 Case Rep 2016;29:34–38. DOI: 10.1016/j.ijscr.2016.10.035.
Biliary colic diagnosis in these patients is a challenge owing 2. Yaghan RJ, Gharaibeh KI, Hammori S. Feasibility of laparoscopic
to the anatomical variation if earlier diagnosis of SIT is not known. cholecystectomy in situs inversus. J Laparoendosc Adv Surg Tech A
The patients usually present with pain left upper abdomen or 2001;11(4):233–237. DOI: 10.1089/109264201750539763.
epigastrium and leading to misdiagnosis and treatment. There is 3. Bozkurt S, Coskun H, Atak T, et al. Single incision laparoscopic
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no evidence of increased incidence of cholelithiasis in SIT patients. cholecystectomy in situs inversus totalis. J Surg Tech Case Rep
2012;4(2):129–131. DOI: 10.4103/2006-8808.110264.
In our study each 40% of patients presented with pain left upper 4. Goyal S, Goyal S, Garg A, et al. Laparoscopic cholecystectomy in situs
abdomen and epigastric pain while the rest 20% with dyspepsia inversus totalis: a review article. Arch Clin Exp Surg 2016;5(3):169–176.
only. This is similar to the studies done earlier. 10 DOI: 10.5455/aces.20150610060815.
World Journal of Laparoscopic Surgery, Volume 15 Issue 1 (January–April 2022) 19