Laparoscopic common bile duct exploration to treat choledocholithiasis in situs inversus patients: A technical review

Figure 1 Preoperative computed tomography showed situs inversus, stones in the gallbladder and the common bile duct, and associated anomalies. A: A gallbladder stone (blue arrows), a common bile duct stone (orange arrows) and a diverticulum at the 3^rd portion of the duodenum (yellow arrows); B: Right upper ureter of the duplication (orange arrows) and lower pelvis of the duplication (yellow arrows); C: Right upper ureter (orange arrows) and right lower ureter (yellow arrows).

Figure 2 Intraoperative photos during single-incision laparoscopic transcystic common bile duct exploration in a patient with situs inversus. A: Dissection of the hepatocystic triangle; B: An opened retrieval basket in a 6 French feeding tube; C: Cystic duct cannulation for intraoperative cholangiography; D: Completion of choledocholithotripsy and cholecystectomy.

Figure 3 Intraoperative cholangiograms during transcystic choledocholithotripsy using a modified “basket in catheter” technique. A: The diagnostic cholangiogram showed an obstructive biliary tree; B: Transcystic basket trawling; C: The completion cholangiogram revealed stone clearance and a patent distal common bile duct.

Figure 4 A practical algorithm for diagnosis and management to treat cholelithiasis and choledocholithiasis in situs inversus patients. ¹Laparoscopic cholecystectomy can be performed with four ports or a single port based on the surgeon’s discretion. LUQ: Left upper quadrant; PE: Physical examination; SI: Situs inversus; DDx: Differential diagnosis; LC: Laparoscopic cholecystectomy; IOC: Intraoperative cholangiography; MRCP: Magnetic resonance cholangiopancreatography; PTGBD: Percutaneous transhepatic gallbladder drainage; PTCD: Percutaneous transhepatic cholangiography and drainage; CBD: Common bile duct; LCBDE: Laparoscopic common bile duct exploration; ERCP: Endoscopic retrograde cholangiopancreatography; EST: Endoscopic sphincterotomy.

Figure 5 Port design in single-incision laparoscopic common bile duct exploration. A: The single-incision multiple-port longitudinal-array technique; B: A commercial multichannel port.