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Implications of Left-sided Gallbladder in the Emergency Setting: Retrospective Review and Top Tips for Safe
Hariscine K Abongwa1, Belinda De Simone, Laura Alberici
1*Department of Emergency and Trauma Surgery, Parma University Hospital, Parma †Surgical Clinic, Department of Experimental and Clinical Sciences, University of Brescia, Brescia ‡Department of Emergency and Trauma Surgery, Maggiore Hospital-Bologna Local Health District, Bologna §Departmente of Surgery, Macerata Hospital, Macerata ∥Unit of General Surgery I, Papa Giovanni XXIII Hospital, Bergamo, Italy ¶David Geffen School of Medicine, University of California, Los Angeles, CA.
Background:
Left-sided gallbladder without situs viscerum inversus (LSG-woSVI) is a rare congenital anomaly. Clinical features and routine presurgical imaging could miss the anomalous position, thereby producing complications during surgery. Laparoscopic cholecystectomy can be performed safely, but the risk of bile duct injury (BDI) is greater than in cholecystectomy of the orthotopic gallbladder. We present a retrospective review of all scientific literature for diagnosed cases of LSG-woSVI undergoing cholecystectomy from 1996 to 2014. Our objectives were to outline empirical top tips for a safe cholecystectomy in incidentally diagnosed LSG-woSVI.
Methods:
We carried a comprehensive search of PubMed using medical subject headings "left-sided gallbladder," "right-sided ligamentum teres" "situs viscerun inversus," "preoperative diagnoses," "cholecystectomy," and "bile duct injury." We considered a classification of the LSG-woSVI in 2 groups: True LSG-woSVI and LSG-woSVI in patients with right-sided ligamentum teres.
Results:
Our retrospective review revealed 55 cases of LSG-woSVI. The mean age was 51 years ±17 SD, male/female ratio was 2:1, clinical presentation was pain in the right upper abdominal quadrant in 75.5%, preoperative diagnosis was reached in 16.3%, True LSG was diagnosed in 83%, acute cholecystitis was found in 50%, laparoscopic cholecystectomy was performed in 79.6%, fundus-first dissection technique was used in 16.7%, intraoperative cholangiography was performed in 39.1%, and BDI occurred in 7.3% of the reported cases.
Conclusions:
Increased awareness of the anatomic aberrations in LSG-woSVI associated with improved preoperative diagnosis and a good knowledge about safe surgical techniques for cholecystectomy could indubitably reduce the incidence of BDI.
