title: Pancreaticoduodenectomy for biliary tract carcinoma with situs inversus totalis: difficulties and technical notes based on two cases.
abstract: Situs inversus totalis (SIT) denotes complete right-left inversion of the thoracic and abdominal viscera. Diagnosis and surgical procedures for abdominal pathology in patients with SIT are technically more complicated because of mirror-image transposition of the visceral organs. Moreover, SIT is commonly associated with cardiovascular and hepatobiliary malformations, which make hepatobiliary-pancreatic surgery difficult. Two cases of pancreaticoduodenectomy for biliary tract carcinoma in patients with SIT are presented. Both patients had an anomaly of the hepatic artery. Advanced diagnostic imaging techniques were very important for careful preoperative planning and to prevent misunderstanding of the arrangement of the abdominal viscera. This facilitated the surgical team's adaptation to the mirror image of the standard procedure and helped avoid intraoperative complications due to cardiovascular and hepatobiliary malformations associated with SIT. Pancreaticoduodenectomy in patients with SIT can be performed successfully with detailed preoperative assessment, use of effective techniques by the surgeon, and appropriate support by assistants.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Kyuno
authors.affiliation: Departments of Surgery, Surgical Oncology and Science, Sapporo Medical University School of Medicine, 1-South, 16-West, Chuo-ku, Sapporo 060-8543, Japan. kimray@sapmed.ac.jp.
authors.forename: Yasutoshi
authors.initials: Y
authors.lastname: Kimura
authors.forename: Masafumi
authors.initials: M
authors.lastname: Imamura
authors.forename: Motonobu
authors.initials: M
authors.lastname: Uchiyama
authors.forename: Masayuki
authors.initials: M
authors.lastname: Ishii
authors.forename: Makoto
authors.initials: M
authors.lastname: Meguro
authors.forename: Masaki
authors.initials: M
authors.lastname: Kawamoto
authors.forename: Toru
authors.initials: T
authors.lastname: Mizuguchi
authors.forename: Koichi
authors.initials: K
authors.lastname: Hirata
mesh_terms: D000368:Aged; D001661:Biliary Tract Neoplasms / Q000601:surgery*; D006801:Humans; D008297:Male; D016577:Pancreaticoduodenectomy / Q000379:methods*; D011379:Prognosis; D012857:Situs Inversus / Q000601:surgery*; D014057:Tomography, X-Ray Computed