Page 72 - World Journal of Laparoscopic Surgery

CASE REPORT
Left-sided Gallbladder: An Intraoperative Surprise

during Laparoscopic Cholecystectomy

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Murugappan Nachiappan , Ravi Kiran Thota , Srikanth Gadiyaram 3
Received on: 06 September 2021; Accepted on: 06 September 2022; Published on: 07 December 2022

AbstrAct
Aim: This article reports a case of the left-sided gallbladder (GB) which is more often than not an intraoperative surprise. The knowledge about
the entity and associated anatomical variations is crucial to prevent complications.
Background: Cholecystectomy is a commonly performed surgical procedure. Left-sided GB is an intraoperative surprise. The reported incidence
of left-sided GB is 0.04–1.1% of cases. There is an increased incidence of variant anatomy and a 7% incidence of bile duct injury in these patients.
Case description: A 29-year-old lady underwent laparoscopic cholecystectomy for symptomatic cholelithiasis. During laparoscopy, the falciform
ligament was unusually stretched toward the right lobe of the liver, going to the region where one would normally see the fundus of GB. Hence,
an additional 5-mm port was placed mid-way between the xiphoid process and umbilicus to the left of midline, apart from the standard ports.
The fundus and the body of the GB were seen to the left of the falciform ligament. While the infundibulum of the GB was anterior and to the
left of the hepatoduodenal ligament, distorting the Calot’s triangle. We proceeded with the “fundus first” approach and could complete the
procedure. Retraction of the fundus toward the right shoulder with a downward and a lateral traction at the infundibulum helped in Calot’s
dissection. The patient had an uneventful postoperative course.
Conclusion: Left-sided GB is a rare anomaly, most often detected intraoperatively. Use of an additional port and the fundus-first approach
helped in successful laparoscopic completion of the procedure.
Clinical significance: This case report highlights an intraoperative surprise, a left-sided GB, encountered in laparoscopic cholecystectomy, one
of the most commonly performed operations. The knowledge about the entity and the associated variations in critical structure anatomy would
be crucial for the surgeons to safely complete the procedure by laparoscopic means.
Keywords: Aberrant gallbladder, Cholecystectomy, Laparoscopy, Left-sided gallbladder.
World Journal of Laparoscopic Surgery (2022): 10.5005/jp-journals-10033-1513

bAckground 1–3 Department of Surgical Gastroenterology and MIS, Sahasra
Cholecystectomy is a commonly performed surgical procedure. Hospitals, Bengaluru, Karnataka, India
Left-sided GB is an intraoperative surprise. The reported incidence Corresponding Author: Srikanth Gadiyaram, Department of Surgical
of left-sided GB is 0.04–1.1% of cases. There is an increased incidence Gastroenterology and MIS, Sahasra Hospitals, Bengaluru, Karnataka,
of variant anatomy and a 7% incidence of bile duct injury in these India, Phone: +91 9880109971, e-mail: srikanthgastro@gmail.com
patients. Herein, we report a case of left-sided GB detected during How to cite this article: Nachiappan M, Thota RK, Gadiyaram S. Left-
surgery who underwent a successful completion of the procedure sided Gallbladder: An Intraoperative Surprise during Laparoscopic
laparoscopically. Cholecystectomy. World J Lap Surg 2022;15(3):258–259.
Source of support: Nil
cAse description Conflict of interest: None
A 29-year-old lady with no comorbidities presented with
complaints of pain in the right hypochondrium for the last from the bed in the body region, and subsequently, the dissection
3 months. Ultrasound evaluation suggested a single gallstone of was carried out toward the neck of the GB. As a next step, retraction
size 1.8 cm. Her liver-function tests were normal. The patient was of the fundus toward the right shoulder with a downward and a
taken up for laparoscopic cholecystectomy after adequate pre- lateral traction at the infundibulum helped in Calot’s dissection. The
anesthetic evaluation. During laparoscopy, the falciform ligament cystic artery and cystic duct were dissected and no other tubular
was unusually stretched toward the right lobe of the liver, going structures were seen entering the GB. The cystic artery and the
to the region where one would normally see the fundus of GB. In duct were clipped and divided in the usual manner. There was no
addition, there were peri-cholecystic omental adhesions. Hence, bleeding encountered during the procedure. The patient had an
an additional 5-mm port was placed mid-way between the xiphoid uneventful postoperative course. She was discharged on the first
process and umbilicus to the left of the midline, apart from the postoperative day on a normal diet (Fig. 1).
standard ports. Then, the pericholecystic omental adhesions were
lysed, after which the fundus and the body of the GB were seen to discussion
the left of the falciform ligament. While the infundibulum of the Cholecystectomy is a commonly performed procedure. The
GB was anterior and to the left of the hepatoduodenal ligament, anatomical position of GB is along the Cantlie line, to the right of
distorting the Calot’s triangle. The Rouviere’s sulcus was seen. We the falciform ligament attached to the undersurface of the liver.
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proceeded with the “fundus first” approach. The GB was dissected Gallbladder in other locations is termed aberrant GB. Left-sided GB
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