Laparoscopic cholecystectomy in a patient with situs inversus totalis: a case report on how to obtain a critical view of safety?

Laparscopic cholecystectomy is considered the procedure of choice in the operative management of cholelithiasis. But despite the maturation of this procedure in surgical practice, bile duct injuries (BDI) still occur at a higher rate than in the open cholecystectomy era. The incidence of BDI post-laparoscopic cholecystectomy approximately 3/1,000 cases. Different recommendations were provided in the recent years to minimize such risks, with special emphasis on the use of the critical view of safety (CVS) to identify the cystic duct and cystic artery before clipping for safe laprscopic cholcystectomy. But when right becomes left and left becomes right, the procedure becomes more demanding & needs special attention to deliver safe procedure. This is the so in patient with SIT. SIT is a rare autosomal recessive anomaly, characterized by transposition of organs to the opposite site of the body as in Fig 1. It was first reported by Fabricius in 1600, and occur in an incidence of about 1: 10 000 to 1: 20 000. In such patient, different scenarios should be in mind to achieve CVS and compensate less skilled non dominant left hand for safe procedure.