Abstract
BACKGROUND Sinistroposition of the gallbladder (SPGB), defined as localization of the gallbladder to the left of the falciform ligament in the absence of situs inversus, is an uncommon congenital anomaly that may complicate laparoscopic cholecystectomy due to altered biliary anatomy and an increased risk of bile duct injury. Routine preoperative imaging frequently fails to identify this variant. CASE REPORT A 53-year-old woman with a long history of symptomatic cholelithiasis underwent elective laparoscopic cholecystectomy. Preoperative ultrasonography demonstrated cholelithiasis without evidence of anatomic variation or biliary obstruction. Intraoperatively, the gallbladder was observed entirely to the left of the round ligament, beneath hepatic segment III, consistent with true SPGB. Careful dissection of Calot's triangle was performed, and the Critical View of Safety was achieved with clear identification of the cystic duct and artery. No biliary anatomic anomalies or intraoperative complications were encountered. The procedure proceeded uneventfully without requiring intraoperative cholangiography. The patient was discharged on postoperative day 1 and remained asymptomatic, with normal laboratory parameters at follow-up. CONCLUSIONS SPGB is a rare anatomic variant that is often diagnosed intraoperatively. Recognition of this condition and strict adherence to safe cholecystectomy principles, particularly achievement of the Critical View of Safety, are essential to prevent bile duct injury and ensure favorable surgical outcomes. Advanced imaging modalities may facilitate preoperative diagnosis and surgical planning.