Navigating postcholecystectomy Bismuth type V benign biliary stricture in situs inversus: challenges in repair and...

A multidisciplinary approach is essential for accurately mapping the biliary anatomy and detecting associated anomalies in situs inversus. Imaging modalities such as contrast-enhanced CT, magnetic resonance cholangiopancreatography (MRCP) and preoperative percutaneous transhepatic biliary drainage can aid in delineating complex biliary strictures. The early identification of lesser curvature of stomach to be traced down to the duodenum, using the umbilical fissure to identify gallbladder fossa and careful orientation of the mesentery of the Roux limb of the jejunum towards the umbilical fissure are key strategies for stricture repair.Postcholecystectomy benign biliary stricture in the presence of situs inversus is a surgical challenge due to the complexity added by inversion of anatomical landmarks. In this report, we present the challenges to be anticipated during stricture repair and the ways to navigate them. We also suggest alternate port placement to ensure safe cholecystectomy in situs inversus (si).We also emphasise higher imaging like MRCP before cholecystectomy in situs inversus, to be fully aware of a possible variant biliary anatomy, as a bile-duct injury in the background of situs inversus makes stricture repair complicated.