Laparoscopic sleeve gastrectomy in a patient with situs inversus totalis: A case report

Abstract

Situs inversus totalis (SIT) is a rare genetic autosomal recessive disorder; however, in identical twins, it may be misinterpreted as X-linked disorder. SIT describes a 270° counterclockwise rotation of the intra-abdominal organs. Laparoscopic surgery in patients with SIT may be more difficult than in normal patients due to its mirror image anatomy. We report a case of a morbidly obese patient (body mass index 36 kg/m 2 ) with SIT who underwent successful laparoscopic sleeve gastrectomy. This article describes all technical details and difficulties of this operation due to the presence of SIT. When performed by an expert laparoscopic surgeon, however, laparoscopic sleeve gastrectomy appears to be a feasible, effective, and safe procedure to treat morbidly obese patients with SIT.

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

“…Surgeons need to pay attention to several points prior to taking a SI patient for surgery. LSG has been proven to be safe in SI [14,16,[25][26][27][28][29][30][17][18][19][20][21][22][23][24]. From the 19 reported SI patients who had LSG, only three cases had complications [15,18,29].…”

“…Nonetheless, the French position used in our case seems to be the most preferred. The French position is believed to provide easy access to the umbilical area and can possibly minimize the effect of reverse anatomy [23,24,27]. More importantly, these cases should be left to the more experienced surgeons with the availability of support if needed as these cases may require additional assistance, identification of anatomical variance, conversion to open surgery, repair of unexpected intraoperative injuries, or managing postoperative complications [14,17,18,[23][24][25][26][27]29,30].…”

“…Additional ports were needed in two cases [19,20] with four cases missing that information [14,21,22]. French position used nine times [16,19,20,[23][24][25][26][27]. The primary surgeon stood between the legs in eight cases [16,20,[23][24][25][26][27], to the left of the patient in six cases [14,15,17,21,28] and to the right in three cases [18,19,22].…”

“…French position used nine times [16,19,20,[23][24][25][26][27]. The primary surgeon stood between the legs in eight cases [16,20,[23][24][25][26][27], to the left of the patient in six cases [14,15,17,21,28] and to the right in three cases [18,19,22]. The surgeon position was missing in two cases [29,30].…”

“…Most of the cases had obesity-related comorbidities. Five cases had prior surgeries [19,25,[27][28][29] with a single article that did not provide surgical history [17]. Only three cases had a perioperative complication [15,18,29].…”