Discussion
SIT is a rare condition characterized by the complete transposition of
both the thoracic and the abdominal viscera along the left-right axis,
thus forming a mirror image of the normal anatomical
picture.1 SIT alone is asymptomatic, except for the
accompaniment of cardiac anomalies associated with dextrocardia, such as
atrial situs solitus, discordant atrioventricular (AV) connection, and
to a lesser extent congenitally corrected transposition of great
arteries (TGA).6,9 Situs inversus is closely
associated with a condition known as PCD. Fifty percent of the patients
with PCD are associated with situs inversus, and together is known as
Kartagener’s Syndrome. 10,11 However, there isn’t
enough evidence that establish the association between SIT and
gallbladder disease. 6,12
While the diagnosis of symptomatic cholelithiasis in patients with SIT
is challenging, since our patient was diagnosed with it on routine
health checkup prior to the development of illness, no particular
challenge was faced in this case. The first successful laparoscopic
cholecystectomy in a patient with situs inversus was performed in 1991
by Campos and Sipes.13 In a similar report, Arya et
al. performed the procedure by placing the ports and the instruments in
a mirror-image fashion to the conventional laparoscopic cholecystectomy.
The primary surgeon performed the dissection, while the first assistant
retracted the Hartmann’s pouch throughout the surgery, thus preventing
the crossing of the hands of the right-handed
surgeon.14 However, Alam and Santra reported
conduction of the procedure with the first assistant holding the camera
through the infraumbilical port and the second assistant retracting the
Hartmann’s pouch.8
Other procedures have also been reported with several modifications. One
of them being adopting the Llyod-Davis Position, with the primary
surgeon standing in between the abducted legs of the
patient.14,15 Cases of Single incision Laparoscopic
Surgery (SILS) have also been reported, with the aim of reducing
invasiveness, improving cosmesis, and avoidance of the crossing of the
instruments.16,17