Laparoscopic sleeve gastrectomy in a patient with situs inversus

Abstract

Background: Obesity in the United States is estimated to be 41.9% in adults over the age of 20 years old. Prevalence of situs inversus totalis is 1 in 10,000 people. With incidence of obesity increasing, the probability of encountering a patient meeting criterion for bariatric surgery with situs inversus increases. Situs inversus presents challenges in pre-operative work up and intra-operative preparation and set up.Objectives: The objective of our paper was to synthesize the information available in literature about Laparoscopic Sleeve Gastrectomy in patients with situs inversus totalis. Additionally, we have added a detailed description of our procedure and outcomes that will hopefully be able to guide a surgeon encountering this situation for the first time. Methods: Case report with literature published within the last 10 years on the management of situs inversus and bariatric surgery. Twenty-three case reports were found after a PubMed literature search that included key search words of “situs inversus”, “Bariatric surgery”, “anastomosis”, “Roux-en-Y”, “gastrectomy”, and / or “obesity”. Results: The results included 12 cases of Laparoscopic SG, 6 cases of Roux-en-Y gastric bypass, 2 cases of laparoscopic one-anastomosis gastric bypass, 1 case of laparoscopic SG with duodeno-jejunal bypass, 1 case of stomach intestinal pylorus sparing surgery (SIPS), and 1 case of laparoscopic biliopancreatic diversion.Conclusion: Based on current literature and our case report, laparoscopic SG can be successfully performed on patients with situs inversus totalis.