Laparoscopic management of left-sided gallbladder with aberrant biliary anatomy: technical considerations and surgical tips

Abstract Left-sided gallbladder (LSG) without situs inversus or “Sinistroposition gallbladder” is a rare anatomical variant that represents a technical challenge during laparoscopic cholecystectomy. It is frequently associated with biliary and vascular anomalies that increase the risk of bile duct injury. We report a 52-year-old male with acute calculous cholecystitis and intraoperative diagnosis of a left-sided gallbladder with severe inflammation and empyema. A modified laparoscopic approach using an additional fifth trocar and a mixed (bidirectional) cholecystectomy technique allowed safe completion of the procedure. Postoperative MRCP documented an associated biliary variant (Taybi type C2). Technical adaptations, including additional trocar placement, altered dissection planes, and mixed antegrade–retrograde cholecystectomy, are essential to safely manage this rare condition. LSG can be safely managed laparoscopically with appropriate technical modifications and strict adherence to biliary safety principles.