Laparoscopic Sleeve Gastrectomy for a Super-Super-Obese Patient with Situs Inversus Totalis

Abstract

Situs inversus totalis is a rare defect which can present difficulties in the management in laparoscopic surgery due to the mirror-image anatomy. Herein, we report a patient with situs inversus totalis and super-super-obesity (BMI 76 kg/m2). We performed successful laparoscopic sleeve gastrectomy. Technical details of this operation, with situs inversus totalis, are presented. There were no major difficulties compared to patients with usual anatomy. There are potential diseases associated with situs inversus and obesity; therefore, a careful investigation, including a chest x-ray and cardiac and abdominal ultrasounds should be performed before surgery. Sleeve gastrectomy is an adequate procedure in super-super-obese patients with situs inversus totalis.

Two-stage laparoscopic biliopancreatic diversion with duodenal switch as treatment of high-risk super-obese patients: analysis of complications

“…There were four reported mortalities (\1%), one due to a traumatic trocar insertion, the second in the perioperative period, the third due to primary peritonitis 3 weeks after surgery even though no leak or bowel ischemia were identified on autopsy and the fourth due to a pulmonary embolism 3 months after surgery [5,7,9,[12][13][14][15][16][17].…”

The First International Consensus Summit for Sleeve Gastrectomy (SG), New York City, October 25–27, 2007

“…It was noted that patients occasionally lost significant weight so that they did not require the second stage. Also, the SG was performed in some patients whose weight was not severe enough to warrant the usual bariatric operations [9][10][11][12][13][14][15][16]. Eventually, some surgeons performed the SG as their sole bariatric operation, going on to a second stage only where the weight loss was inadequate [17].…”

Roux-en-Y gastric bypass in a patient with situs inversus totalis – a case report

“…the accessory hepatic artery branching from the left gastric artery). In the published literature, there have been only 5 reports of laparoscopic adjustable gastric banding [17][18][19][20][21], 1 report of laparoscopic sleeve gastrectomy [22] and 2 reports of laparoscopic Rouxen-Y gastric bypass [23,24] in patients with situs inversus. Atypical organ orientation may be a problem for a laparoscopic surgeon and in that case a minimally invasive procedure requires more technical and mental preparation of the surgeon and staff of the operating theatre.…”

“…The final position of the small gastric pouch and the jejunum is mirrored but in fact surgical manoeuvres do not require switching hands, using any special instruments or radically changing the operating room setup. The difficulty of using the right hand in place of the left hand during laparoscopic sleeve gastrectomy in a patient with situs inversus was mentioned by Catheline et al [22]. However, an obvious benefit of laparoscopy is that a procedure can be converted into open surgery.…”