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Case Reports
. 2025 Sep 1;19(1):436.
doi: 10.1186/s13256-025-05207-0.

Overcoming mirror anatomy: surgical strategies for laparoscopic cholecystectomy in situs inversus totalis: a case report

Iqra Khanzada  1 , Sheeren Taj  1 , Ghafoor Dalwani  1 , Syed Raheel  2 , Altaf K Talpur  1 , Jemal Girma Mohammad  3
Affiliations
Case Reports

Overcoming mirror anatomy: surgical strategies for laparoscopic cholecystectomy in situs inversus totalis: a case report

Iqra Khanzada et al. J Med Case Rep. .

Abstract

Background: Situs inversus totalis is an uncommon congenital condition characterized by the complete reversal of internal organ placements from their usual orientation. This syndrome presents challenges in both diagnostic and surgical care owing to the anatomical reversal, with an incidence rate of around 1 in 5000 to 20,000 infants.

Case presentation: A 50-year-old Asian Sindhi Ayan female patient with well-managed hypertension presented with intermittent cramp-like discomfort in the upper left region of her abdomen, which exacerbated after consuming fatty foods, accompanied by feelings of nausea and vomiting. Diagnostic imaging verified the presence of gallstones as the cause of symptoms, as well as a condition called situs inversus totalis. The individual had a planned surgical procedure called laparoscopic cholecystectomy. The surgical arrangement was changed to accommodate the mirrored anatomy, which included using a four-port approach and adjusting the location of the surgical team. The gallbladder was effectively extracted, and a subhepatic drain was inserted. The procedure had a duration of 65 minutes, and there were no anatomical deviations seen in the bile duct system.

Discussion: The presence of situs inversus totalis makes it more difficult to address abdominal disorders since the organs are not in their usual positions. This example highlights the need of using specialized surgical procedures and comprehensive preoperative preparation to accommodate the inverted anatomy.

Conclusion: Achieving successful laparoscopic surgery in patients with situs inversus totalis requires meticulous preparation and flexible approaches to overcome the specific difficulties posed by the reversed arrangement of organs.

Keywords: Cholecystectomy; Laproscopy; Situs inversus totalis.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Institute approved IRB. Grant number is 6603 dated 10–06 - 2024.The approaches were conducted in compliance with the applicable rules and legislation. The patient’s data presented in this publication have not been previously reported. A copy of the written consent is available for review by the Editor-in-Chief of this journal on request. Consent for publication: Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal. Competing interests: None.

Figures

Fig. 1
Fig. 1
Operating room setup and team position
Fig. 2
Fig. 2
Pictorial presentation of the abdomen and portals—A umbilical camera portal (10 mm), B epigastric port (10 mm), C dissecting portal (5 mm), and D retracting portal (5 mm)
Fig. 3
Fig. 3
Intraoperative picture showing omentum adherence to liver and gall bladder
See this image and copyright information in PMC

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References

    1. Multani A, Parmar S, Dixon E. Laparoscopic vs. robotic gastrectomy in patients with situs inversus totalis: a systematic review. Minim Invasive Surg. 2023;2023:1–11. 10.1155/2023/3894561. - PMC - PubMed
    1. Kamitani S, Tsutamoto Y, Hanasawa K, Tani T. Laparoscopic cholecystectomy in situs inversus totalis with “inferior” cystic artery: a case report. World J Gastroenterol: WJG. 2005;11(33):5232–4. 10.3748/wjg.v11.i33.5232. - PMC - PubMed
    1. Iskandar ME. Laparoscopic cholecystectomy for a left-sided gallbladder. World J Gastroenterol: WJG. 2013;19(35):5925. 10.3748/wjg.v19.i35.5925. - PMC - PubMed
    1. Bozkurt S, Coskun H, Atak T, Kadioglu H. Single incision laparoscopic cholecystectomy in situs inversus totalis. J Surg Techn Case Rep. 2012;4(2):129. 10.4103/2006-8808.110264. - PMC - PubMed
    1. Salama IA, Abdullah MH, Houseni M. Laparoscopic cholecystectomy in situs inversus totalis: feasibility and review of literature. Int J Surg Case Rep. 2013;4(8):711–5. 10.1016/j.ijscr.2013.02.030. - PMC - PubMed

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