Case report
Laparoscopic cholecystectomy in patient with situs viscerum inversus

Background: Situs viscerum inversus is a genetic defect with an autosomal recessive inheritance occurring in population with the incidence of 1:20 000. The mirror-image anatomy creates some difficulties in performing laparoscopic cholecystectomy (LCh). Aim: The aim of this analysis was to present technical aspects associated with LCh in a patient with situs viscerum inversus. Material and methods: A 60-years old female patient with a symptomatic cholelithiasis was qualified to LCh. Ultrasonography of the abdomen revealed situs viscerum inversus. The surgeon and the second assistant (operating the camera) were standing on the right side of the patient, while the first assistant – on the left side. The camera was inserted through a 10-mm trocar introduced after minilaparotomy just below the umbilicus. Another 10-mm trocar was placed in the median line to the left of the falciforme ligament. Two 5-mm trocars were inserted in the left mesogastrium, respectively in the mid-clavicular and anterior axillary lines. Results: Laparoscopy confirmed situs viscerum inversus. Standard laparoscopic cholecystectomy was successfully performed with no complications. The presence of situs viscerum inversus brought some adaptatability difficulties to the whole operating team. There were no complications during the post-surgery follow-up. The patient was discharged on the fourth day after the surgery. Conclusions: 1. Situs viscerum inversus is not a contraindication for laparoscopic cholecystectomy 2. The emplacement of the trocars and the location of the surgeons were mirror-imaged in relation to typical conditions 3. Laparoscopic cholecystectomy may be safely performed in patients with situs viscerum inversus, although due to the mirror-image anatomy – some difficulties in orientation appear.