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Ueda T, Tanaka T, Kirihataya Y, Hara C, Yoshimura A. Laparoscopic cholecystectomy and common bile duct exploration for gallstone and common bile duct stone in a patient with a left-sided gallbladder: a case report. JOURNAL OF MINIMALLY INVASIVE SURGERY 2023; 26:218-221. [PMID: 38098356 PMCID: PMC10728684 DOI: 10.7602/jmis.2023.26.4.218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 02/16/2023] [Accepted: 02/27/2023] [Indexed: 12/21/2023]
Abstract
Left-sided gallbladder is a rare finding that is mostly discovered incidentally during surgery and is often associated with anatomic anomalies. We herein report a case in which laparoscopic cholecystectomy and common bile duct exploration were achieved for an 89-year-old female patient with left-sided gallbladder. Surgery was carried out using our usual trocar position. Calot triangle was covered by the body of the gallbladder and could not be detected. We dissected the gallbladder from the fundus towards the neck. The cystic duct joined the common bile duct from the right side, and common bile duct exploration was performed routinely without perioperative comorbidities. Although the preoperative diagnosis rate is low and the risk of intraoperative bile duct injuries in patients with left-sided gallbladder is high, laparoscopic cholecystectomy and common bile duct exploration can be safely performed by understanding the location and bifurcation of the cystic duct.
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Affiliation(s)
- Takeshi Ueda
- Department of Surgery, Minami-Nara General Medical Center, Nara, Japan
| | - Tetsuya Tanaka
- Department of Surgery, Minami-Nara General Medical Center, Nara, Japan
| | - Yuki Kirihataya
- Department of Surgery, Minami-Nara General Medical Center, Nara, Japan
| | - Chisato Hara
- Department of Surgery, Minami-Nara General Medical Center, Nara, Japan
| | - Atsushi Yoshimura
- Department of Surgery, Minami-Nara General Medical Center, Nara, Japan
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Rondelli F, Bugiantella W, Chillitupa CIZ, Marcacci C, De Rosa M. Left-sided gallbladder: A rare biliary tree anomaly. Hepatobiliary Pancreat Dis Int 2023; 22:655-657. [PMID: 36781311 DOI: 10.1016/j.hbpd.2023.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 01/18/2023] [Indexed: 02/15/2023]
Affiliation(s)
- Fabio Rondelli
- Department of Surgical and Biomedical Sciences, School of Medicine, University of Perugia, Via G. Dottori, 06100, Perugia, Italy; General and Specialized Surgery Unit, "Santa Maria" Hospital, Via T. Di Joannuccio, 1, 05100, Terni, Italy
| | - Walter Bugiantella
- Department of General Surgery, "Nuovo San Giovanni Battista" Hospital, Usl Umbria 2, Via M. Arcamone, 1, 06034, Foligno, PG, Italy
| | | | - Claudio Marcacci
- General and Specialized Surgery Unit, "Santa Maria" Hospital, Via T. Di Joannuccio, 1, 05100, Terni, Italy
| | - Michele De Rosa
- Department of General Surgery, "Nuovo San Giovanni Battista" Hospital, Usl Umbria 2, Via M. Arcamone, 1, 06034, Foligno, PG, Italy.
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Kaldas P, Goh SK, Weinberg L, Hodgson R. Laparoscopic choledochoscopy for choledocholithiasis is possible in the anatomical anomaly of left gallbladder. BMJ Case Rep 2022; 15:e251278. [PMID: 36535740 PMCID: PMC9764652 DOI: 10.1136/bcr-2022-251278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Laparoscopic cholecystectomy (LC) is more challenging in the anatomical variation of left-sided gallbladder with the anomaly also highly related to biliary anomalies. Therefore, there has been a reluctance to operate close to the common bile duct (CBD) in left gallbladder patients, and thus choledocholithiasis is usually treated with endoscopic retrograde cholangiopancreatography (ERCP). There is emerging evidence that single stage LC and CBD exploration for choledocholithiasis may be superior to two stage LC and ERCP in terms of short-term and long-term morbidity, cost and length of stay. With the re-emergence of laparoscopic choledochoscopy, the purpose of this case report is to demonstrate the feasibility of this approach for choledocholithiasis.
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Affiliation(s)
- Peter Kaldas
- Department of Surgery, Northern Hospital Health Sciences Library, Epping, Victoria, Australia
- Department of Surgery, Austin Health, Heidelberg, Victoria, Australia
| | - Su Kah Goh
- Department of Surgery, Northern Hospital Health Sciences Library, Epping, Victoria, Australia
| | - Laurence Weinberg
- Department of Anaesthesia, Austin Health, Heidelberg, Victoria, Australia
- Department of Critical Care, University of Melbourne, Melbourne, Victoria, Australia
| | - Russell Hodgson
- Department of Surgery, Northern Hospital Health Sciences Library, Epping, Victoria, Australia
- Department of Surgery, University of Melbourne, Epping, New South Wales, Australia
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Zheng B, Li C, Wang S, Wu J. Laparoscopic cholecystectomy for true left-sided gallbladder: A rare anatomical anomaly and the related diagnosis and treatment challenges. Asian J Surg 2022; 45:3012-3013. [PMID: 35794036 DOI: 10.1016/j.asjsur.2022.06.147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 06/23/2022] [Indexed: 12/15/2022] Open
Affiliation(s)
- Bingfeng Zheng
- Department of General Surgery, the First People's Hospital of Guangyuan City, Guangyuan, 628000, Sichuan, China.
| | - Chunshan Li
- Department of General Surgery, the First People's Hospital of Guangyuan City, Guangyuan, 628000, Sichuan, China
| | - Shaoyuan Wang
- Department of General Surgery, the First People's Hospital of Guangyuan City, Guangyuan, 628000, Sichuan, China
| | - Jumei Wu
- Department of General Surgery, the First People's Hospital of Guangyuan City, Guangyuan, 628000, Sichuan, China
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Guachilema Ribadeneira A, Palacios Gordon M, Morocho S, Bahamonde EG, Basantes AD, Parra Valverde E. Left-sided gallbladder 'sinistroposition' associated with an anatomical variant of cystic duct insertion: case report. J Surg Case Rep 2022; 2022:rjac510. [PMID: 36389441 PMCID: PMC9659430 DOI: 10.1093/jscr/rjac510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 10/14/2022] [Indexed: 12/29/2022] Open
Abstract
True left-sided gallbladder (LSGB) is a rare congenital anomaly with an incidence of 0.1-1.2%. It is more common in women than in men at a ratio of 5:1. Its etiology is unknown, although several theories have been proposed. The symptoms are similar to those of a normal gallbladder, which makes the preoperative diagnosis difficult despite imaging studies. In most cases, the diagnosis is achieved intraoperatively. LSGB is associated with biliary anomalies, and the incidence of biliary tract lesions is high. Four-port laparoscopic cholecystectomy is a safe procedure for LSGB. Surgical technique varies according to each case. Preoperative imaging studies have low sensitivity for diagnosis, and the surgeon should be familiar with ductal and vascular anatomical variants in addition to possessing the ability to change the conventional surgical technique to optimize the exposure and minimize the risk of bile duct injury.
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Affiliation(s)
| | | | - Sandra Morocho
- Anestesiología, Hospital General Enrique Garces, Quito, Ecuador
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Malla S, Karki S, Bohara S, Upadhaya Regmi B, Bhat PS, Sedhai S, Paudel S, Rawal SB. Sinistroposition: A case report on incidental finding of left sided gall bladder on laparoscopic cholecystectomy. Ann Med Surg (Lond) 2022; 81:104547. [PMID: 36147104 PMCID: PMC9486847 DOI: 10.1016/j.amsu.2022.104547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 08/27/2022] [Accepted: 08/27/2022] [Indexed: 11/18/2022] Open
Affiliation(s)
- Srijan Malla
- Department of General and Gastrointestinal Surgery, Nepal Mediciti Hospital, Lalitpur, 44700, Nepal
| | | | - Sujan Bohara
- Department of General and Gastrointestinal Surgery, Nepal Mediciti Hospital, Lalitpur, 44700, Nepal
- Corresponding author.
| | | | - Pawan Singh Bhat
- Department of General and Gastrointestinal Surgery, Nepal Mediciti Hospital, Lalitpur, 44700, Nepal
| | - Swastika Sedhai
- Kathmandu University School of Medical Science, Kavre, 45210, Nepal
| | - Suman Paudel
- Metrocity Hospital Private Limited, Kaski, 33700, Nepal
| | - Sushil Bahadur Rawal
- Department of General and Gastrointestinal Surgery, Nepal Mediciti Hospital, Lalitpur, 44700, Nepal
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Almas T, Murad MF, Mansour E, Khan MK, Ullah M, Nadeem F, Shafi A, Khedro T, Almuhaileej M, Abdulhadi A, Alshamlan A, Nagarajan VR, Mansoor E. Look, but to the left: A rare case of gallbladder sinistroposition and comprehensive literature review. Ann Med Surg (Lond) 2021; 71:103016. [PMID: 34840764 PMCID: PMC8606894 DOI: 10.1016/j.amsu.2021.103016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 10/31/2021] [Accepted: 10/31/2021] [Indexed: 11/29/2022] Open
Abstract
Left-sided gallbladder (LSGB) is a rare anatomic variation that, while benign in the context of its transposition, is of significant intraoperative importance. Due to its association with other anatomic anomalies involving key structures in the hepatobiliary system, discovering it intraoperatively as opposed to preoperatively suddenly increases the difficulty of a gallbladder procedure. Left-sided gallbladder (LSGB) is a rare anatomic variation that, while benign in the context of its transposition, is of significant intraoperative importance. Although laparoscopic cholecystectomy of a LSGB is safe, it is associated with higher risk of complications such as common bile duct injury. Most cases of a LSGB are diagnosed intraoperatively, and this sudden discovery during the procedure can increase the difficulty, duration, and stress of the procedure due to the other potential anatomic anomalies that LSGB is associated with in the hepatobiliary system.
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Affiliation(s)
- Talal Almas
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - Eyad Mansour
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - Muneeb Ullah
- Department of Surgery, Maroof International Hospital, Islamabad, Pakistan
| | - Faisal Nadeem
- Department of Surgery, Maroof International Hospital, Islamabad, Pakistan
| | - Adil Shafi
- Department of Surgery, Maroof International Hospital, Islamabad, Pakistan
| | - Tarek Khedro
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | | | | | | | - Emad Mansoor
- Division of Gastroenterology and Liver Disease, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
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Laparoscopic cholecystectomy for left-sided gallbladder. Langenbecks Arch Surg 2021; 407:207-212. [PMID: 34240246 DOI: 10.1007/s00423-021-02263-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 06/30/2021] [Indexed: 12/07/2022]
Abstract
PURPOSE Left-sided gallbladder (LSGB) is a rare congenital anomaly in the gallbladder, which is defined as a gallbladder located on the left side of the falciform ligament without situs inversus. We retrospectively analyzed 13 patients diagnosed with LSGB in a single center to confirm the safety of laparoscopic cholecystectomy (LC) and reviewed the anatomical implications in those patients. METHODS Of the 4910 patients who underwent LC for the treatment of gallbladder disease between August 2007 and December 2019, 13 (0.26%) were diagnosed as having LSGB. We retrospectively analyzed these 13 patients for general characteristics, perioperative outcomes, and other variations through the perioperative imaging workups. RESULTS All patients underwent LC for gallbladder disease. In all cases, the gallbladder was located on the left side of the falciform ligament. The operation was successfully performed with standard four-trocar technique, confirming "critical view of safety (CVS)" as usual without two cases (15.4%). In one case, which had an intraoperative complication and needed choledochojejunostomy because of common bile duct injury, there was an associated variation with early common bile duct bifurcation. The other patient underwent an open conversion technique because of severe fibrosis in the Calot's triangle. Furthermore, on postoperative computed tomography, abnormal intrahepatic portal venous branching was found in all cases. CONCLUSIONS Although LSGB is usually encountered by chance during surgery, it can be successfully managed through LC with CVS. However, surgeons who find LSGB have to make efforts to be aware of the high risk of bile duct injury and possibility of associated anomalies.
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Printes TRM, Rabelo ÍEC, Cauduro JF, Lopez EC, Dos Santos CFV, Melo TFC, Regino HGA, Machado AAP. Left-sided gallbladder (LSG) associated with true diverticulum, a case report. AME Case Rep 2020; 4:26. [PMID: 33178998 DOI: 10.21037/acr-20-55] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 06/28/2020] [Indexed: 11/06/2022]
Abstract
The left-sided gallbladder (LSG) is a rare type of anatomical variation (ectopia) defined by the location of the bladder to the left side of the liver falciform and round ligaments. Initially reported in 1886 by Hochstetter, the finding is usually accidental since it is mostly an asymptomatic condition, thus not causing the patient any harm and being few reported cases in the current literature. Surgical cases are most associated with gallstones such as presented in this case report. Our patient was a 60-year-old man from Manaus who presented with symptomatic acute cholelithiasis submitted to laparoscopic cholecystectomy which allowed the visualization of true LSG concomitant with a polyp suggestive lesion. A diagnosis post-cholecystectomy of true gallbladder diverticulum was confirmed by histopathological analysis. Being one of three types of LSG, true LSG is more associated with other structural changes in the biliary tree and also some liver changes, in our case we identified no such alterations. True gallbladder diverticulum has, as the main characteristic, the herniation of all tissues of the gallbladder wall. When presented with LSG, is important to correctly identify the altered structures and adjust the surgical technique in the best way possible, it is up to the surgeon to adapt to the situation presented and ensure the best treatment for his patient.
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Affiliation(s)
| | | | - Júlia F Cauduro
- Medical School of Federal University of Amazonas (UFAM), Manaus, Amazonas, Brazil
| | - Estevan C Lopez
- Medical School of Federal University of Amazonas (UFAM), Manaus, Amazonas, Brazil
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Mok SK, Paik KY, Kim YJ. Antegrade method of laparoscopic cholecystectomy for left sided gallbladder. Asian J Surg 2020; 43:511-512. [PMID: 31917031 DOI: 10.1016/j.asjsur.2019.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 11/17/2019] [Indexed: 11/16/2022] Open
Affiliation(s)
- Sang Kyun Mok
- Department of Surgery, College of Medicine, Yeouido St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Kwang Yeol Paik
- Department of Surgery, College of Medicine, Yeouido St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea.
| | - Yeon Ji Kim
- Department of Ear, Otolaryngology and Head and Neck Surgery, College of Medicine, St.Vincent Hospital, The Catholic University of Korea, Seoul, South Korea
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Pereira R, Perera M, Roberts M, Avramovic J. Surgical approach to a left-sided gallbladder. BMJ Case Rep 2019; 12:12/8/e230681. [PMID: 31420438 DOI: 10.1136/bcr-2019-230681] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Biliary colic is a pain in the right upper quadrant or epigastrium thought to be caused by functional gallbladder spasm from a temporary obstructing stone in the gallbladder neck, cystic duct or common bile duct. A 56-year-old man presented with frequent episodes of typical biliary colic. At initial laparoscopy, the gallbladder was absent from its anatomic location. Further inspection revealed a left-sided gallbladder (LSGB), suspended from liver segment 3. Preoperative ultrasound, the most common imaging modality for symptomatic gallstones, has a low positive predictive value for detecting LSGB (2.7%). Laparoscopic cholecystectomy (LC) was delayed to attain additional imaging. A magnetic resonance cholangiopancreatography demonstrated the gallbladder left of the falciform ligament with the cystic duct entering the common hepatic duct from the left. The patient underwent an elective LC 8 weeks later. The critical view of safety is paramount to safe surgical dissection and could be safely achieved for LSGB.
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Affiliation(s)
- Ryan Pereira
- Princess Alexandra Hospital, Woolloongabba, Queensland, Australia.,Mater Hospital Pimlico, Aitkenvale, Queensland, Australia
| | - Marlon Perera
- Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Matthew Roberts
- Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - John Avramovic
- Mater Hospital Pimlico, Aitkenvale, Queensland, Australia
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