Laparoscopic Sleeve Gastrectomy in a Patient With Situs Inversus Totalis and Kartagener Syndrome

Abstract

Laparoscopic sleeve gastrectomy (LSG) is a widely accepted and adopted procedure to achieves weight loss in morbid obesity. Situs inversus (SI) is when the body's visceral organs are not in the normal position with reversal of anatomical orientation. Patients with obesity and SI can be challenging to diagnose and manage. We present a case of a 23-year-old male who has SI totalis with Kartagener syndrome who underwent LSG to treat morbid obesity. Furthermore, we conducted a comprehensive review of the current medical literature. We conclude that LSG can be safely performed in SI. However, it is recommended to leave such cases to more experienced surgeons. In addition, it is advisable to consider few unconventional technical operative methods before surgery. Nevertheless, more data are needed to better study LSG in SI patients, which can be difficult given the rare nature of SI.

Sleeve gastrectomy in a patient with situs inversus: a case report

“…SI is a very rare congenital disease affecting one in 10 000 people. It is characterized by a mirror image transposition of both abdominal and thoracic organs where it is called SI totalis or it may involves partially one compartment only [ 7 , 8 ]. It can be associated with vascular, cardiac, abdominal and respiratory anomalies (Kartagener syndrome).…”

“…It can be associated with vascular, cardiac, abdominal and respiratory anomalies (Kartagener syndrome). Therefore, it is necessary to diagnose SI preoperatively and to be managed by a multidisciplinary team to avoid perioperative complications [ 8 , 9 , 10 ]. Most of the SI patients do not have clinical problems that are related to their abnormal anatomy and discovered incidentally.…”

“…Also knowing that patient has SI preoperatively gives the surgeon time to adapt mentally and physically before surgery. The surgeon will plan for trochars placement and team position to avoid technical difficulties [ 8 , 10 ].…”

“…To facilitate cognitive adaptation to reverse anatomy, we advise to review radiological imaging before surgery and using continuous reminders and cross-checks by surgical team during surgery [ 8 , 11 ]. To overcome technical difficulties, we found that French position gives good exposure and fast adaptation to the reverse anatomy of stomach [ 8 , 9 , 10 ] .…”

Situs Inversus Totalis: A Clinical Review

“…Many other surgical procedures have been reported in SIT patients. These include sleeve gastrectomy for morbid obesity, 100,101 proximal gastric resection, 102 "distal" gastric resection, 103,104 total gastrectomy for malignancy, 105,106 laparoscopic pancreato-duodenectomy, 107 nephrectomy, 108 complicated choledochal cyst 109 and different colorectal operations, eg, sigmoid resection, rectal resection, etc. 110,111 We previously published a case of malignant masquerade biliary stricture in a situs inversus totalis patient (who gave his written consent to that) when distal resection of the common bile duct, cholecystectomy and hilar lymphadenectomy were performed.…”