Laparoscopic Cholecystectomy In Situs Inversus Totalis (SIT): A Case Series – Modified French Technique Provides Optimum Outcomes

BACKGROUND: Situs inversus totalis (SIT) is a rare congenital condition characterized by the mirror-image reversal of thoracic and abdominal organs. Its incidence is between 0.04% and 0.30%. Patients with SIT presenting with cholelithiasis pose diagnostic and technical challenges, particularly during laparoscopic cholecystectomy (LC), due to reversed anatomic landmarks and difficulties in orientation. METHODS: We conducted a retrospective review of 12 patients with SIT who underwent LC between September 2006 and April 2023 at our tertiary center. Preoperative evaluation included hematology, liver function tests, ultrasonography, cardiac, and pulmonary assessments. Surgeries were performed under general anesthesia using a modified French technique in mirror-image configuration. A harmonic scalpel (ultracision) was used for dissection in all cases. RESULTS: Out of 5375 LCs performed during the study period, 12 were in patients with SIT (prevalence: 0.22%). All procedures were completed laparoscopically without conversion. One case required port site modification for optimal clip application. Two patients underwent gallbladder decompression, and one developed postoperative ileus, which resolved conservatively. No intraoperative complications, bile duct injuries, or mortalities were observed. CONCLUSION: Laparoscopic cholecystectomy in SIT patients is safe and feasible when performed by experienced surgeons. Modifications in surgical technique and port placement are essential to accommodate the reversed anatomy. Preoperative planning and intraoperative vigilance are key to minimizing complications and achieving outcomes comparable to anatomically normal patients.