Doctors at Fortis Memorial Research Institute, Gurugram successfully conducted a challenging laparoscopic gall bladder surgery on a 46-year-old woman, whose abdominal organs were translocated in the reverse positions known as Situs Inversus(the right-side organs on the left and left side organs on the right).A rare congenital condition –Situs Inversus, leads to difficulties in diagnosis andsurgical treatment of abdominal conditions demanding more skill and preparation on the part of the surgeon. A recent medical advancement in laparoscopic surgery of the gallbladder,the surgery was conducted via a single incision(one Port). The team of doctors led by Dr Ajay Kumar Kriplani, Director, Minimal Access Bariatric and G I Surgery, Fortis Memorial research Institute, Gurugram performed the complex procedure and the patient was discharged after two days in a stable condition.As per the available medical literature, this is the first time such a successful surgery for gall bladder has been performed through one port in India and only the third such surgery performed in the world.
The patientwas admitted at Fortis Memorial research Institute, Gurugram with complaints of recurrent pain in the upper left side of the abdomen. On examination, her ultrasound reports revealed stones in the gall bladder, which was situated in the left upper abdomen (instead of being on the right side). Not only this, the appendix was also on the left side(instead of right). Her stomachsigmoid colon and her heart were on the right side instead of being on the left. This condition is known as Situs Inversus with dextro-cardia.
Giving details of the surgery, Dr Ajay Kumar Kriplani, Director, Minimal Access Bariatric and G I Surgery at Fortis Memorial research Institute, Gurugram said, “We operated and removedthe gall bladder in the patient via a single port laparoscopic surgery leading to good recovery and superior cosmetic results.Thesurgical treatment for such a rare condition becomes particularly challenging in advanced laparoscopic procedures. Laparoscopic removal of the gall bladder is conventionally performedwith 4 cuts (ports). In this case, we removed the gall bladder with a single port laparoscopic surgerywhich is our preferred method with experience of thousands of such surgeriesleading to good recovery -lesser pain, scarring and morbidity. For laparoscopic gall bladder removal, the surgeon normally stands on the left side of the patient alongwith a camera person and the monitors are placed on the right side. For Situs inversus, we stood on the right side of the patient and the monitor was placed on the left. A single 1.2 cm cut was made in the belly button through which telescope and instruments were inserted and the gall bladder was removed through the same cut.”
“Performing laparoscopic surgery for mirror-image anatomy is rare and a challenging process,owing to reverse placing of instruments, (left sided instrument to right of telescope and vice versa) orientation and dissection during the procedure for a right-handed surgeon.This gets all the more difficult when a single incision surgery where only one cut is made, and the instruments are closer to each other than conventional 4 port surgery.Clinically, situs inversus by itself is asymptomatic. A medical imaging can help clarify the diagnosis when symptoms are atypical due to situs anomalies and are helpful to assess fine anatomical details, which play a crucial role in these cases to plan surgical interventions.” Dr Kriplani added.
Mahipal Singh Bhanot, Senior Vice President & Business Head, Fortis Memorial Research Institute said, “This was a very challenging case, considering the rare condition of the patient. However, correct diagnosis alongwith precision surgery by the expert team of doctors led by Dr Ajay Kumar Kriplanihelped treat the patient.”
Situs inversus totalis (SIT) is a rare congenital abnormality characterized by a mirror-image transposition of both the abdominal and the thoracic organs. This is a global defect of situs orientation and failure to generate normal left-right asymmetry.Frequency of situs inversus is 1:10,000 to 1:20,000 and is more frequent in males.