Single Incision Laparoscopic Cholecystectomy in situs Inversus Totalis

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Date: July-December 2012
Publisher: Medknow Publications and Media Pvt. Ltd.
Document Type: Disease/Disorder overview
Length: 1,562 words
Lexile Measure: 1340L

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Byline: Suleyman. Bozkurt, Halil. Coskun, Tuba. Atak, Huseyin. Kadioglu

Situs inversus totalis (SIT) is a rare genetic anomaly characterized by arrangement of the abdominal and thoracic organs in a perfect mirror image reversal of the normal positioning. Transposition of the organs causes difficulty in diagnosis and treatment of the diseases related to abdomen and thorax. Single incision laparoscopic surgery (SILS) is a new technique and it is increasingly used with better cosmetic results. In this paper, a single incision laparoscopic cholecystectomy (SILC) performed in a patient with SIT is presented. SILC can be performed safely in the patients with SIT with better cosmetic results.

Introduction

Situs inversus totalis (SIT) is a rare congenital condition seen in 0.01% of the population. [sup][1] It is characterized by the transposition of major thoracic organs and all of abdominal visceral organs to the opposite side of the body. The liver and gallbladder are located on the left side of the abdomen, while the stomach and the spleen are on the right side. Even though the etiology is not known exactly, it is thought to be due to a genetic defect occurring within the second week of embryonic life. It is seen equally in both genders. [sup][2],[3]

Laparoscopic cholecystectomy has become the gold standard for treatment of symptomatic gallbladder calculi in late 1900s. [sup][4] However, trend for minimizing of surgical trauma lead to development of new techniques in laparoscopic surgery. In 1997, Navara et al . performed cholecystectomy via two umbilical ports and using three-sling-sutures. [sup][5] Since then, single incision laparoscopic surgery (SILS) entered a rapid development. It has promising advantages such as better cosmetic result and lesser postoperative pain.

In this manuscript, single incision laparoscopic cholecystectomy (SILC) performed in a case with SIT is presented.

Case Report

A 49-year-old man who was known to have SIT, was admitted for elective cholecystectomy due to cholelithiasis. He presented to the department of surgery with complaints of left sided pain in the hypochondrium accompanied with nausea and vomiting after meals. The electrocardiogram and chest X-rays shows signs of dextrocardia [Figure 1]. On ultrasonographic evaluation, the right lobe of the liver and gallbladder were found on the left side; the spleen was visualized on the right. The gallbladder was filled with several gallstones. The common bile duct was normal in diameter. In the operating room, the surgeon and...

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Gale Document Number: GALE|A328234663