J Korean Surg Soc.  2010 Dec;79(6):513-517. 10.4174/jkss.2010.79.6.513.

Laparoscopy Assisted Subtotal Gastrectomy in Gastric Cancer Patient with Situs Inversus in Korea

• Kang BH
• Lee SL
• Hur H
• Kim JY
• Cho YK
• Han SU

• KMID: 2096611
• DOI: http://doi.org/10.4174/jkss.2010.79.6.513

Abstract

Situs inversus totalis is a congenital condition in which there is complete right to left reversal of the thoracic and abdominal organ. According to an increase in minimally invasive treatments, laparoscopic surgery for patients with situs inversus totalis has also been increasing. We performed laparoscopy-assisted subtotal gastrectomy on a 60-year-old gastric cancer patient with situs inversus totalis. He was diagnosed with early stage gastric adenocarcinoma at antrum of the anterior wall. We experienced some technical difficulties because of the position and anatomic variation of major vessels. However, the subtotal gastrectomy was completed with D1+ beta lymph node dissection followed by extracorporeal gastroduodenostomy. The patient was discharged six days after operation without any complications. The pathologic report showed that tumor invasion was limited to the submucosa and one lymph node was positive for metastasis. We believe our experience is the first reported case of laparoscopic gastric cancer surgery for situs inversus in Korea.

Keyword

Situs inversus; Laparoscopic surgery; Gastrectomy

MeSH Terms

Adenocarcinoma
Anatomic Variation
Gastrectomy
Humans
Korea
Laparoscopy
Lymph Node Excision
Lymph Nodes
Middle Aged
Neoplasm Metastasis
Situs Inversus
Stomach Neoplasms

Figure

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  Fig. 1 Preoperative study for patients with situs inversus totalis. (A) esophagogastroduodenoscopy showed ulcerative lesion on antrum. (B) chest x-ray showed inverted viscera "mirror image". (C, D) Abdominal CT scan, variation of vessels was examined.

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  Fig. 2 Operative finding in patients with situs in versus totalis. (A) Inversed intraabdominal organ. (B) Anomaly of major vessels (Rt. Gastric artery from aorta).

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  Fig. 3 Arrangement of trocars. Incision was made between two trocar sites and extra-coporealanastomosis was done.

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