Laparoscopic common bile duct exploration on a patient with situs inversus totalis and previous biliary surgery: a case report

Introduction and importance: Laparoscopic common bile duct (CBD) exploration (LCBDE) is a standard treatment for extrahepatic biliary stones. While previous biliary surgery and situs inversus totalis (SIT) are not absolute contraindications, they significantly increase operative complexity. Cases of LCBDE in patients with both SIT and a history of biliary surgery are exceptionally rare. Case presentation: A 38-year-old female with SIT and a history of open CBD exploration presented with recurrent CBD stones and cholangitis. The patient underwent LCBDE, including choledochotomy and stone extraction via choledochoscopy. Technical modifications included a central surgical position, adjusted trocar placement to accommodate adhesions, and meticulous adhesiolysis. Clinical discussion: LCBDE is increasingly used in patients with prior biliary surgery, yielding outcomes comparable to those in primary cases. However, SIT presents unique challenges regarding surgical anatomy and ergonomics. This case demonstrates that LCBDE is a feasible and safe approach in this complex population, provided there is careful preoperative planning for reversed anatomy and sufficient laparoscopic expertise. Conclusion: LCBDE is safe and effective for patients with SIT and previous biliary interventions. Success relies on adapting the surgical environment, specifically the “split-leg” position and mirror-image trocar configurations, to overcome altered anatomical landmarks.