Laparoscopic Cholecystectomy in a Morbidly Obese Patient With Situs Inversus Totalis: A Case Report

Area of Science:

• Surgical Innovation
• Congenital Malformations
• Gastrointestinal Surgery

Background:

• Situs inversus totalis (SIT) is a rare congenital condition involving mirror-image transposition of thoracic and abdominal organs.
• Laparoscopic cholecystectomy (LC) in SIT patients presents unique surgical challenges due to reversed anatomy.
• Morbid obesity further complicates LC procedures in patients with SIT.

Observation:

• A morbidly obese patient with SIT presented with symptomatic biliary colic.
• The patient successfully underwent laparoscopic cholecystectomy utilizing modified port sites and patient positioning (reverse Trendelenburg with left tilt).
• Surgical orientation and dexterity were significantly impacted by the patient's reversed anatomy and obesity.

Findings:

• Successful laparoscopic cholecystectomy was performed in a morbidly obese patient with situs inversus totalis.
• The procedure required adaptation of standard surgical techniques, including mirror-image port placement and specific patient positioning.
• Despite challenges, the outcome was successful, aligning with previous reports in the literature.

Implications:

• Laparoscopic cholecystectomy is a viable option for morbidly obese patients with SIT.
• Surgeons require advanced laparoscopic skills, meticulous technique, and careful planning to manage anatomical variations.
• Emphasis on avoiding iatrogenic injuries is critical in these complex surgical cases.