Document Type : Case reports


1 Professor of General Surgery, Endoscopic and Minimally Invasive Surgery Research Center, Ghaem Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

2 Assistant Professor of General Surgery, Faculty of Medicine, Islamic Azad University, Mashhad Branch, Mashhad, Iran

3 Assistant Professor of General Surgery, Surgical Oncology Research Center, Emam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran


Background: Situs Inversus Totalis (SIT) is a rare and silent autosomal recessive disease in which all organs are on the opposite side. Diagnosis of gallbladder diseases will be difficult due to these anatomical changes. Laparoscopic cholecystectomy is the standard treatment for gallbladder diseases but is technically challenging for patients.
Case presentation: Two 52- and 64-year-old women with known SIT who complained of intermittent epigastric pain and nausea after eating fatty and bulky meals were examined. With the help of abdominal ultrasound, a gallbladder on the left side of the abdomen with multiple gallstones was shown.
Conclusion: Since the successful primary cholecystectomy was performed on a patient with SIT in 1991, several modifications have been made for port insertion. Surgeons try to overcome technical problems by making various adjustments compared to conventional laparoscopic cholecystectomy.
Laparoscopic cholecystectomy in patients with SIT is safe. However, laparoscopic cholecystectomy is challenging due to anatomical changes in the SIT. Our proposed method of port placement helps right-handed surgeons for safer and easier dissection.


  1. Campos L, Sipes E. Laparoscopic cholecystectomy in a 39-year-old female with situs inversus. J Laparoendosc Surg. 1991;1(2):123-5. doi: 10.1089/lps.1991.1.123. [PubMed: 1834260].
  2. Tsoucalas G, Thomaidis V, Fiska A. Situs inversus totalis: always recall the uncommon. Clin Case Rep. 2019;7(12):2575-6. doi: 10.1002/ccr3.2433. [PubMed: 31893103].
  3. Phothong N, Akaraviputh T, Chinswangwatanakul V, Trakarnsanga A. Simplified technique of laparoscopic cholecystectomy in a patient with situs inversus: a case report and review of techniques. BMC Surg. 2015;15(1):23. doi: 10.1186/s12893-015-0012-6. [PubMed: 25880817].
  4. Malik FS, Butt UI, Khan WH, Bilal SM, Umar M. Laparoscopic cholecystectomy in situs inversus totalis. J Coll Physicians Surg Pak. 2019;29(10):1000-2. doi: 10.29271/jcpsp.2019.10.1000. [PubMed: 31564278].
  5. Demiryilmaz I, Yilmaz I, Albayrak Y, Peker K, Sahin A, Sekban N. Laparoscopic cholecystectomy in patients with situs inversus totalis: literature review of two patients. Iran Red Crescent Med J. 2012;14(12):826-8. doi: 10.5812/ircmj.4806. [PubMed: 23482252].
  6. Du T, Hawasli A, Summe K, Meguid AA, Lai C, Sadoun M. Laparoscopic cholecystectomy in a patient with situs inversus totalis: Port placement and dissection techniques. Am J Case Rep. 2020;21:e924896. doi: 10.12659/AJCR.924896. [PubMed: 32886654].
  7. Agha RA, Borrelli MR, Farwana R, Koshy K, Fowler AJ, Orgill DP, et al. The SCARE 2018 statement: updating consensus Surgical CAse REport (SCARE) guidelines. Int J Surg. 2018;60:132-6. doi: 10.1016/j.ijsu.2018.10.028. [PubMed: 30342279].
  8. Alkhlaiwy O, Almuhsin AM, Zakarneh E, Taha MY. Laparoscopic cholecystectomy in situs inversus totalis: case report with review of techniques. Int J Surg Case Rep. 2019;59:208-12. doi: 10.1016/j.ijscr.2019.05.050. [PubMed: 31181389].
  9. Chaouch MA, Jerraya H, Dougaz MW, Nouira R, Dziri C. A systematic review of laparoscopic cholecystectomy in situs inversus. J Investig Surg. 2019;34(3):324-33. doi: 10.1080/08941939.2019.1622822. [PubMed: 31164015].
  10. Mohammed AA, Arif SH. Laparoscopic cholecystectomy for left-sided gall bladder in situs inversus totalis patient, a technically demanding procedure. Ann Med Surg. 2019;47:1–4. doi: 10.1016/j.amsu.2019.09.002. [PubMed: 31645939].
  11. Zatir S, Medjamea A, Bouazzaoui A, Lounici S, Bouchakor S, Kroumli B, et al. Laparoscopic cholecystectomy on complete situs inversus : about a case, how does it work ? Surg Clin J. 2020;2:28-9.
  12. Moyon C MA, Rojas CL, Moyon C FX, Aguayo WG, Molina GA, Ochoa C, et al. Acute cholecystitis and residual choledocholithiasis in a situs inversus patient, successful laparoscopic approach and ERCP a case report from Ecuador. Ann Med Surg. 2020;54:101-5. doi: 10.1016/j.amsu.2020.04.012. [PubMed: 32426127].
  13. Rungsakulkij N, Tangtawee P. Fluorescence cholangiography during laparoscopic cholecystectomy in a patient with situs inversus totalis: a case report and literature review. BMC Surg. 2017;17(1):43. doi: 10.1186/s12893-017-0242-x. [PubMed: 28427402].