World Journal of Laparoscopic Surgery

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VOLUME 15 , ISSUE 3 ( September-December, 2022 ) > List of Articles

CASE REPORT

Left-sided Gallbladder: An Intraoperative Surprise during Laparoscopic Cholecystectomy

Murugappan Nachiappan, Ravi Kiran Thota, Srikanth Gadiyaram

Keywords : Aberrant gallbladder, Cholecystectomy, Laparoscopy, Left-sided gallbladder.

Citation Information : Nachiappan M, Thota RK, Gadiyaram S. Left-sided Gallbladder: An Intraoperative Surprise during Laparoscopic Cholecystectomy. World J Lap Surg 2022; 15 (3):258-259.

DOI: 10.5005/jp-journals-10033-1513

License: CC BY-NC 4.0

Published Online: 08-12-2022

Copyright Statement:  Copyright © 2022; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Aim: This article reports a case of the left-sided gallbladder (GB) which is more often than not an intraoperative surprise. The knowledge about the entity and associated anatomical variations is crucial to prevent complications. Background: Cholecystectomy is a commonly performed surgical procedure. Left-sided GB is an intraoperative surprise. The reported incidence of left-sided GB is 0.04–1.1% of cases. There is an increased incidence of variant anatomy and a 7% incidence of bile duct injury in these patients. Case description: A 29-year-old lady underwent laparoscopic cholecystectomy for symptomatic cholelithiasis. During laparoscopy, the falciform ligament was unusually stretched toward the right lobe of the liver, going to the region where one would normally see the fundus of GB. Hence, an additional 5-mm port was placed mid-way between the xiphoid process and umbilicus to the left of midline, apart from the standard ports. The fundus and the body of the GB were seen to the left of the falciform ligament. While the infundibulum of the GB was anterior and to the left of the hepatoduodenal ligament, distorting the Calot's triangle. We proceeded with the “fundus first” approach and could complete the procedure. Retraction of the fundus toward the right shoulder with a downward and a lateral traction at the infundibulum helped in Calot's dissection. The patient had an uneventful postoperative course. Conclusion: Left-sided GB is a rare anomaly, most often detected intraoperatively. Use of an additional port and the fundus-first approach helped in successful laparoscopic completion of the procedure. Clinical significance: This case report highlights an intraoperative surprise, a left-sided GB, encountered in laparoscopic cholecystectomy, one of the most commonly performed operations. The knowledge about the entity and the associated variations in critical structure anatomy would be crucial for the surgeons to safely complete the procedure by laparoscopic means.


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