Three-port laparoscopic cholecystectomy with common bile duct exploration in situs inverse totalis: a case report and literature review.

INTRODUCTION

The anatomical variations in patients with situs inverse totalis (SIT) pose unique challenges to laparoscopic cholecystectomy with common bile duct exploration (LC + LCBDE) that relies on conventional anatomical memory.

CASE PRESENTATION: In this case report, we present a 59-year-old female patient who presented with a 2-year history of recurrent upper abdominal pain that had worsened over the preceding 5 days. After evaluation, she was diagnosed to be a case of SIT with cholelithiasis, obstructive jaundice, acute biliary pancreatitis and atrial fibrillation. She subsequently underwent LC + LCBDE. The procedure was performed using a three-port technique: the 5-mm trocar port at the subxiphoid site was primarily used for gallbladder retraction and also served as the access path for choledochoscopic exploration, while the 10-mm port in the left lumbar region was mainly utilized for resection maneuvers and functioned as the channel for the clip applier. During the operation, silt-like stones in the bile duct were irrigated and cleared under choledochoscopic guidance, followed by primary closure of the choledochotomy. The patient's postoperative recovery was uneventful, and discharge was achieved on the second postoperative day.

CONCLUSION

This case highlights the technical challenges of performing laparoscopic biliary surgery in a patient with SIT. The strategic placement of trocar ports was crucial for minimizing surgical trauma and ensuring procedural safety. Furthermore, given the patient's comorbidity of atrial fibrillation, our management demonstrates that meticulous perioperative preparation and a tailored surgical strategy can facilitate enhanced recovery in complex SIT cases.