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Laparoscopic cholecystectomy for left-sided gallbladder (sinistroposition).
Prasanna Kumar Reddy1, R Venkata Subramanian, S Yuvaraja
1Department of Surgical Gastroenterology, Apollo Hospitals, Chennai, Tamil Nadu, India. reddypk@eth.net
JSLS : Journal of the Society of Laparoendoscopic Surgeons
|August 27, 2005
Summary
Left-sided gallbladder transposition, without situs inversus, is a rare anomaly. Surgeons must be aware of this unusual gallbladder position and its unpredictable ductal anatomy for safe laparoscopic surgery.
Area of Science:
- Gastroenterology
- Surgical Anatomy
- Medical Imaging
Background:
- Transposition of the gallbladder to the left side, in the absence of complete situs inversus viscerum, represents a rare congenital anomaly.
- This anatomical variation positions the gallbladder beneath the left liver lobe, typically in segments III or IV, or left of the falciform ligament.
Observation:
- Routine preoperative imaging may fail to identify this gallbladder anomaly, potentially surprising surgeons during laparoscopic procedures.
- The cystic duct's confluence with the common bile duct can be unpredictable in these cases.
Findings:
- Laparoscopic management requires heightened awareness of the gallbladder's atypical location.
- Careful attention to the cystic duct's insertion point is crucial.
Implications:
- Intraoperative cholangiography is a valuable tool for navigating the anomalous biliary anatomy.
- Safe laparoscopic cholecystectomy in patients with left-sided gallbladder transposition necessitates meticulous surgical planning and execution.