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LETTER TO THE EDITOR |
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| Year : 2012 | Volume
: 8
| Issue : 2 | Page : 65 |
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Laparoscopic cholecystectomy and appendicectomy in situ inversus totalis
Ketan Vagholkar
Department of Surgery, Padmashree Dr. D. Y. Patil Medical College, Nerul, Navi Mumbai, Maharashtra, India
| Date of Web Publication | 2-May-2012 |
Correspondence Address:
Ketan Vagholkar
Annapurna Niwas, 229 Ghantali Road, Thane-400 602
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0972-9941.95542
How to cite this article:
Vagholkar K. Laparoscopic cholecystectomy and appendicectomy in situ inversus totalis. J Min Access Surg 2012;8:65 |
Dear Sir,
I read the article entitled "Laparoscopic cholecystectomy and appendicectomy in situ inversus totalis: A case report and review of literature". [1]
The message conveyed by the authors seems to be misleading. Situs inversus is a rare and deceptive congenital condition, which every general surgeon should bear in mind during the course of evaluation of abdominal pain. However, the diagnosis should not be problematic as USG or even higher forms of imaging such as CT scanning are always done prior to surgical intervention. In addition, prior to anaesthesia every patient will undergo chest X-ray examination which will confirm the diagnosis by way of dextrocardia. Once confirmed, the positions of the ports for either cholecystectomy or for appendicectomy will be on the opposite site as a mirror image. This may sound easy but will demand high level of manual dexterity during the course of dissection. The authors' decision to carry out appendicectomy along with cholecystectomy is misleading and debatable. In the report presented, there is no evidence of classical acute attack of inflammation of either of the organs. From the description, it appears that the patient had clinical evidence of appendicitis with radiological evidence of cholelithiasis. With the advent of laparoscopy, it has become a prevalent practice guided by purely unscientific reasons to perform combination surgeries such as appendicectomy with cholecystectomy or hysterectomy with appendicectomy or cholecystectomy. With the exception of a few anecdotal reports, it is unusual to find two unrelated pathologies involving unrelated organs to run parallel and give rise to two sets of acute clinical features warranting a two-in-one surgery typically designated as "combo" surgery. [2]
This type of practice is surely confusing the minds of both trainee and budding surgeons and needs to be curtailed.
| ¤ References | |  |
| 1. | Borgaonkar VD, Deshpande SS, Kulkarni VV. Laparoscopic cholecystectomy and appendicectomy in situ inversus totalis: A case report and review of literature. J Min Access Surg 2011;7:242-5. 
[PUBMED]  |
| 2. | Black RB. Double pathology in acute cholecystitis. Aust N Z J Surg 1997;47:798-801.
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