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 Table of Contents     
LETTER TO THE EDITOR
Year : 2012  |  Volume : 8  |  Issue : 4  |  Page : 164-165
 

Laparoscopic cholecystectomy and appendicectomy in situs inversus totalis


Department of Surgery, Andhra Medical College, K.G.H, Visakhapatnam, Andhra Pradesh, India

Date of Web Publication2-Nov-2012

Correspondence Address:
Sugunakara Rao Kodi
Department of Surgery, Andhra Medical College, K.G.H, Visakhapatnam, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-9941.103135

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How to cite this article:
Kodi SR. Laparoscopic cholecystectomy and appendicectomy in situs inversus totalis. J Min Access Surg 2012;8:164-5

How to cite this URL:
Kodi SR. Laparoscopic cholecystectomy and appendicectomy in situs inversus totalis. J Min Access Surg [serial online] 2012 [cited 2019 May 23];8:164-5. Available from: http://www.journalofmas.com/text.asp?2012/8/4/164/103135


Dear Sir,

I read with interest the recent case report, "laparoscopic cholecystectomy and appendicectomy in situs inversus totalis: a case report and review of literature," written by Borgaonkar et al. [1]

I want to share a few technical aspects of laparoscopic cholecystectomy in situs inversus patients. For right-handed surgeons, dissection of Calot's triangle using unskilled non-dominant left hand, manipulation may be cumbersome, not precise.

We can overcome this difficulty using three techniques:

  1. Dissection of Calot's triangle using right hand via the epigastric port, by allowing first assistant to retract on Hartmann's pouch, as the author has described. [2]
  2. Dissection of Calot's triangle can be done by using a forceps through the trocar located in midline between epigastric and umbilical ports; traction on Hartmann's pouch can be done by left hand of the surgeon via epigastric port. [3]
  3. Surgeon standing between legs of the patient in lithotomy position
However, left-handed surgeon has a clear advantage, because he is able to alternate the performance of dissection manoeuvres between the right and left hand as has been reported in the literature. [4]

I, also, want to share one clinical aspect of this case. Most patients present with left-sided upper abdominal pain. However, about 10% of patients with left-sided cholelithiasis present with right-sided abdominal pain. This phenomenon has been observed for both visceral biliary pain and somatic pain in cases of cholecystitis and suggests that the central nervous system may not share in the general transposition. I have seen one case of appendicitis who presented with pain in right iliac fossa; we found that the patient had situs inversus in ultrasonogram and dextrocardia in chest x-ray. We have done laparoscopic appendicectomy, which is present in left iliac fossa. A high index of suspicion is hence the key to avoiding mishaps in patients with situs inversus presenting with an acute abdomen. [5]

 
  References Top

1.Borgaonkar VD, Deshpande SS, Kulkarni VV. Laparoscopic cholecystectomy and appendicectomy in situs inversus totalis: A case report and review of literature. J Minim Access Surg 2011;7:242-5.  Back to cited text no. 1
[PUBMED]    
2.McKay D, Blake G. Laparoscopic cholecystectomy in situs inversus totalis: A case report. BMC Surg 2005;5:5.  Back to cited text no. 2
[PUBMED]    
3.Aydin U, Unalp O, Yazici P, Gurcu B, Sozbilen M, Coker A. Laparoscopic cholecystectomy in a patient with situs inversus totalis. World J Gastroenterol 2006;12:7717-9.  Back to cited text no. 3
[PUBMED]    
4.Oms LM, Badia JM. Laparoscopy cholecystectomy in situs inversus totalis: The importance of being left handed. Surg Endosc 2003;17:1859-61.  Back to cited text no. 4
[PUBMED]    
5.Takei HT, Maxwell JG, Clancy TV, Tinsley EA. Laparoscopic cholecystectomy in situs inversus totalis. J Laparoendosc Surg 1992;2:171-6.  Back to cited text no. 5
    




 

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