Document Type

Conference Proceeding

Publication Date

3-12-2025

Publication Title

Surgical Endoscopy

Abstract

Objectives: Encountering aberrant biliary anatomy is a known risk factor for inadvertent injury while performing biliary surgery. One described anatomic aberrancy, sinistroposition of the gallbladder (also known as ‘‘left sided gallbladder’’), is a rarely seen anatomic abnormality with an incidence of 0.2% to 1.1%. Given the infrequent encounters with this abnormality and its association with other anatomic anomalies, extreme care and caution should be exercised when performing a cholecystectomy in this patient population. Methods: We present the case of a 37-year-old male who presented with abdominal pain and was diagnosed with Tokyo Grade I acute calculous cholecystitis. An ultrasound of the abdomen demonstrated gallstones, evidence of acute cholecystitis, and an 11 mm common bile duct, but no other abnormalities. The patient was taken to the operating room for laparoscopic cholecystectomy. The abdomen was entered using a supraumbilical Hassan cutdown technique with subsequent standard laparoscopic port placement in the epigastrium and right upper quadrant. On initial inspection, the gallbladder was found to be attached to the left lateral segment, consistent with sinistroposition of the gallbladder. The decision was made to proceed with a laparoscopic, top-down (fundus first) approach to decrease the risk of injuring other aberrant vascular structure or biliary radicles. After difficult dissection off of the cystic plate we identified a solitary artery and duct terminating into the gallbladder. Preoperative indocyanine green (ICG) was also used, helping further characterize the patient’s biliary anatomy prior to control and division of any structures. No other aberrant biliary anatomy was identified, and the gallbladder was removed without incident. Final pathology demonstrated acute cholecystitis. Conclusion: Sinistroposition of the gallbladder is a rare anatomic abnormality that when encountered should be approached with caution and likely a change in standard operative approach. The condition is often discovered incidentally and intraoperatively, and this anatomy should alert the operator to the possibility of abnormal anatomy that may lead to an overall increased risk of complications. To more clearly define biliary and vascular anatomy in this clinical scenario, we recommend using a ‘‘top down’’ approach starting at the fundus, combined with ICG or further biliary imaging prior to dividing any structures.

Volume

39

Issue

Suppl 1

First Page

S280

Comments

2025 SAGES Annual Meeting, March 12-15, 2025, Long Beach, CA.

DOI

10.1007/s00464-025-11690-9

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