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

Situs inversus totalis (SIT) is a rare congenital condition characterized by a mirror-image transposition of both the abdominal and the thoracic organs. Due to the reversal of organs, laparoscopic cholecystectomy (LC) poses a significant challenge in patients with SIT. After the first reported case of LC in a patient with SIT in 1991, 120 more such reports have been published in the literature, but very few of them were carried out on morbidly obese patients. We report a morbidly obese patient, a known case of SIT, who presented with persistent biliary colic and underwent successful laparoscopic cholecystectomy in our institution. At surgery we used reverse Trendelenburg position with left tilt up and mirror-image of usual laparoscopic cholecystectomy port sites for the procedure. The procedure proved to be challenging, both due to the morbid obesity of the patient and the reversal of organs, which affected orientation and dexterity. A successful outcome has been reported in all the cases before us as well as our case, but it is noteworthy to mention that such cases must be performed by well-trained laparoscopic surgeons with impeccable manual dexterity who must take extreme care to avoid iatrogenic injuries.