First Case of Laparoscopic Cholecystectomy in a Patient with Situs Inversus Totalis in Ethiopia

Abstract

Situs inversus totalis (SIT) is a rare genetic condition that presents a significant challenge for laparoscopic surgery because of its mirror-image anatomy. While reported globally, this is the first documented case of laparoscopic cholecystectomy (LC) for symptomatic cholelithiasis in a patient with SIT in Ethiopia. A 43-year-old female with known SIT presented to the hospital with a 5-year history of dyspepsia and left upper quadrant abdominal pain. Ultrasound confirmed cholelithiasis. After a thorough preoperative workup to rule out associated syndromes, she underwent elective LC. A modified trocar placement and the “French” patient position were utilized to accommodate the anatomical reversal and facilitate the procedure for a right-handed surgical team. LC is a feasible and safe procedure for patients with SIT, even in settings where laparoscopy is emerging. The French position can simplify the procedure by minimizing the cognitive and technical load for the surgeon, avoiding the need for a complete mirror-image setup. This case underscores the potential for expanding advanced minimally invasive techniques in Ethiopia through collaborative education and training.