title: A case report of laparoscopic cholecystectomy in situs inversus totalis: Technique and anatomical variation.
abstract: BACKGROUND
  Since the first laparoscopic cholecystectomy report in situs inversus totalis in 1991, the safety of this procedure has still been questionable. A few surgeons were preferred to perform an open cholecystectomy due to technical difficulties as well as various anatomical varieties that can be faced during surgery.
  
  
  METHODS
  We report a case report of a 50 years old patient came with epigastric pain that radiated to her left shoulder, intermittent nausea, vomiting and bloating after some meals. She did not associate her symptoms with fatty food. She was a known case of situs inversus totalis and had a previous laparoscopic Nissen fundoplication that we performed 5 years ago. A laparoscopic cholecystectomy was performed by a left-handed surgeon, illustrating challenges, technique, and the advantages of left-handed surgeon over right-handed ones.
  
  
  CONCLUSIONS
  After the first discovery of situs inversus totalis by Fabricus in the 1600 the standard procedure for cholelithiasis was open surgery. The introduction of the first laparoscopic cholecystectomy in patients with situs inversus put surgeons in challenge for performing laparoscopic rather than open surgery for patients with situs inversus diagnosed with gallbladder disease. Only 67 cases used laparoscopic cholecystectomy in treating situs inversus patients with cholelithiasis. Although technical difficulties and expected anatomical variation are the main challenges in those patients, the current literature confirms the safety of laparoscopy in such cases.
  
  
  CONCLUSIONS
  Despite having all these difficulties, handling this type of operations can be safe and uneventful especially with experienced surgeon.
authors.affiliation: Department of surgery, Damascus General Hospital, Damascus, Syria; Department of surgery, Faculaty of Medicine, Syrian Private University (SPU), Syria. Electronic address: drsabekb@gmail.com.
authors.forename: Mhd Belal
authors.initials: MB
authors.lastname: Alsabek
authors.affiliation: Department of surgery, Damascus General Hospital, Damascus, Syria. Electronic address: shawki1290@gmail.com.
authors.forename: Shawqi
authors.initials: S
authors.lastname: Arafat
authors.affiliation: Department of surgery, Damascus General Hospital, Damascus, Syria. Electronic address: alaa.dirani@hotmail.com.
authors.forename: Alaa
authors.initials: A
authors.lastname: Aldirani
keywords: Anatomical variation; Cholelithiasis; Laparoscopic cholecystectomy; Situs inversus