Look beyond the Mirror: Laparoscopic Cholecystectomy in Situs Inversus Totalis-A Systematic Review and Meta-Analysis (and Report of New Technique).

Autor: Enciu O; Department of Surgery, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania.; General Surgery Department, Elias Emergency University Hospital, 011461 Bucharest, Romania., Toma EA; Department of Surgery, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania.; General Surgery Department, Elias Emergency University Hospital, 011461 Bucharest, Romania., Tulin A; Faculty of Medicine-Discipline of Anatomy, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania., Georgescu DE; Department of Surgery, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania.; I. Cantacuzino Clinical Hospital, 030167 Bucharest, Romania., Miron A; Department of Surgery, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania.; General Surgery Department, Elias Emergency University Hospital, 011461 Bucharest, Romania.
Jazyk: angličtina
Zdroj: Diagnostics (Basel, Switzerland) [Diagnostics (Basel)] 2022 May 19; Vol. 12 (5). Date of Electronic Publication: 2022 May 19.
DOI: 10.3390/diagnostics12051265
Abstrakt: Background: Laparoscopic cholecystectomy in situs inversus totalis (SIT) is a technically and physically demanding procedure for surgeons and there is still a lack of consensus regarding the best technical approach in such cases. We conducted a systematic review and meta-analysis to evaluate port placement, the dominant hand of the surgeon, preoperative imaging, morbidity, and mortality.
Methods: We searched MEDLINE, SCOPUS, Web of Science, and the Cochrane Library for studies of patients with SIT that underwent laparoscopic cholecystectomy. Of 387 identified records, 101 met our inclusion criteria, all of them case reports or case series of maximum of 6 patients.
Results: Out of the 121 patients included in the analysis, 94 were operated on using a "mirrored American" technique, 12 using the "Mirrored French", 9 employed single-port techniques, and 6 described novel port placements. Even though most surgeries were conducted by a right-handed surgeon (93 cases), surgeries performed by the seven left-handed surgeons yielded shorter intervention times ( p = 0.024). Preoperative imaging (CT, MRI, MRCP, ERCP) also correlated with a lower duration of surgery ( p = 0.038. Length of stay was associated with the type of disease, but not with other studied endpoints. Morbidity was less than 1%, and conversion rates and mortality were nil.
Conclusions: Cholecystectomy in SIT is a safe but challenging procedure and surgeons should prepare in advance for the unfamiliar aspects of completing such a task. While preoperative imaging and a left-handed surgeon are beneficial in terms of surgery length, when these are not available surgeons should focus on achieving the most comfortable setting based on their experience and tailor their approach to the patient at hand. Further studies are needed in order to properly describe and evaluate intraoperative findings as well as surgeon-dependent factors that could improve future recommendations.
Databáze: MEDLINE
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