Journal of Minimal Access Surgery

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

Laparoscopic cholecystectomy and appendicectomy in situs inversus totalis

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

Correspondence Address:
Sugunakara Rao Kodi
Department of Surgery, Andhra Medical College, K.G.H, Visakhapatnam, Andhra Pradesh
India




How to cite this article:
Kodi SR. Laparoscopic cholecystectomy and appendicectomy in situs inversus totalis.J Min Access Surg 2012;8:164-165


How to cite this URL:
Kodi SR. Laparoscopic cholecystectomy and appendicectomy in situs inversus totalis. J Min Access Surg [serial online] 2012 [cited 2022 Jan 22 ];8:164-165
Available from: https://www.journalofmas.com/text.asp?2012/8/4/164/103135


Full Text

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:



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]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]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

1Borgaonkar 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.
2McKay D, Blake G. Laparoscopic cholecystectomy in situs inversus totalis: A case report. BMC Surg 2005;5:5.
3Aydin 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.
4Oms LM, Badia JM. Laparoscopy cholecystectomy in situs inversus totalis: The importance of being left handed. Surg Endosc 2003;17:1859-61.
5Takei HT, Maxwell JG, Clancy TV, Tinsley EA. Laparoscopic cholecystectomy in situs inversus totalis. J Laparoendosc Surg 1992;2:171-6.