Laparoscopic Cholecystectomy for Cholelithiasis Complicated by Right Hepatic Lobe Hypoplasia—A Case Report—

Abstract

Right hepatic lobe hypoplasia is a rare abnormality, and congenital hepatic lobe hypoplasia is the primary cause, with stenosis and portal vein and bile duct obstructions being secondary causes. Hepatic lobe hypoplasia is often associated with gallbladder malposition, which can lead to torsion and compression of the gallbladder duct, causing biliary stasis and cholelithiasis. Laparoscopic cholecystectomy for cholelithiasis has not been recommended in such cases because of the difficulty approaching the gallbladder. A 72-year-old man with recurrent cholecystitis was referred to our hospital for surgical treatment. Preoperative computed tomography (CT) showed severe atrophy of the right hepatic lobe and dorsally deviated position of the gallbladder in the abdominal cavity. Furthermore, due to the compensatory hypertrophy of the left hepatic lobe, difficulty in maintaining the surgical field was anticipated. Based on the preoperative blood tests and CT, it was thought that the severe atrophy of the right hepatic lobe was caused by congenital hypoplasia. In the present case, laparoscopic cholecystectomy was performed safely with the patient in the left lateral tilt position to secure a clear view of the surgical field. There were no complications after surgery.