Full Text Article Open Access

Case report

Laparoscopic Sleeve gastrectomy in Situs Inversus Totalis (video).

Taha Mohamed Hassan 1*, El Berry Mohamed 1, Al Emadi Mohamed abdullah1

1 Department of bariatric surgery Al Emadi Hospital Doha Qatar *Corresponding author Correspondence to: Dr.taha@alemadihospital.com.qa Publication data: Submitted: January 10 ,2018 Accepted: January 27,2018 Available Online: January31,2018 This article was subject to full peer-review.

Abstract

Introduction: Situs inversus totalis (SIT) is a rare autosomal recessive entity defined as the transposition of thoracic and intraabdominal organs forming a mirror image to the normal anatomy. Laparoscopic procedures are technically more challenging for the surgeons in case of SIT. We hereby report two cases of successful laparoscopic gastric sleeve in SIT patients. Case presentation: Case 1 A 33-year-old morbidly obese female patient (body mass index (BMI): 42.7 kg/m2) was admitted for bariatric surgery. She is known to have Situs Inversus Totalis, but no chronic disease neither history previous surgery. Preoperative Chest X-ray Showed dextrocardia, Barium swallow showed the stomach and duodenum in mirror position (figure1). A Laparoscopic sleeve gastrectomy was performed successfully under general anesthesia in supine position and surgeon on the left side and assistant on the right side of the patient. The postoperative courses were uneventful; patient was discharged on the 2nd postoperative day. Case 2 A 41 -year-old morbidly obese female patient (BMI: 41.7 kg/m2) was admitted for bariatric surgery. She was Asthmatic with no history of previous abdominal procedures. The preoperative investigations confirmed the SIT. Intraoperative exploration showed mirror transposition of all the intraabdominal organs (figure 2). A standard Laparoscopic gastric sleeve was performed successfully with uneventful postoperative courses.

a b

Figure 1. a: Dextrocardia

b: Stomach and duodenum in mirror position

Figure 2. mirror presentation of the intraabdominal organs

Discussion:

Situs Inversus is a rare congenital developmental anomaly with autosomal recessive inheritance. This entity is characterized by a reversed chest and abdomen organs position along a sagittal plane. The incidence of partial situs inversus in less than 1 in 22000. Partial presentations were also described. The diagnosis of situs inversus can be made through, X-rays, ultrasounds, barium enema, and abdominal computed tomography [1-5].

Laparoscopic surgery in situs inversus has been reported in few cases of gastric sleeve. Some other procedures have been successfully performed such as laparoscopic gastric banding, and laparoscopic gastric bypass [6,7].

The most important issue on which almost all the surgeons who presented their experiences focused was the intraoperative management since most of the patients are known to have SIT at the moment of the bariatric procedure [8].

Gastric sleeve and other bariatric surgeries are always challenging but no major complications related to the mirror anatomy presentation have been reported. However, it is recommended that an experienced laparoscopic surgeon carry out the procedure [9-13]. A summary of the described case of bariatric procedures done in patients with SIT is showed in table 1.

Conflict of interest: none

References:

[1] Wittgrove AC, Clark GW. Laparoscopic gastric bypass for morbid obesity in a patient with situs inversus. J Laparoendosc Adv Surg Tech. 1998; A 8:53-55.

[2] Ahmed AR, O’malley W. Laparoscopic. Roux-en-Y gastric bypass in a patient with situs inversus. Obes. Surg 2006; 16:1392-94.

[3] Tsepelidis D, Loi P, Katsanos G, Closset J. Gastric bypass for morbid obesity in a patient with situs inversus totalis. Acta Chir Belg.2015; 115:81-82.

[4] Stier C, El-Sayes I, Theodoridou S. Are laparoscopic bariatric procedures feasible in morbidly obese patients with situs inversus? A report of 2 cases and a brief review. Surg Obes Relat Dis20 17;10: e53–e56.

[5] Catheline JM, Rosales C, Cohen R, Bihan H, Fournier JL, Roussel J, Bénichou J. Laparoscopic sleeve gastrectomy for a supersuper- obese patient with situs inversus totalis. Obes Surg.2006 16: 1092-95.

[6] Deutsch GB, Gunabushanam V, Mishra N, Sathyanarayana SA, Kamath V, Buchin D. Laparoscopic vertical sleeve gastrectomy after open gastric banding in a patient with situs inversustotalis. J Minim Access Surg.2012 8:93–96.

[7] Genser L, Tayar C, Eddine IK. Trans-umbilical single ıncision laparoscopic sleeve gastrectomy in a patient with situs ınversus totalis and kartagener syndrome: video report. Obes Surg.2015; 25:1985-86.

[8] Ersoy E, Koksal H, Ege B. Laparoscopic gastric banding for morbid obesity in a patient with situs inversus totalis.Obes Surg.2005; 15:1344–46.

[9] Samaan M, Ratnasingham A, Pittathankal A, Hashemi M. Laparoscopic adjustable gastric banding for morbid obesity in a patient with situs inversus totalis. Obes Surg.2008; 18:898-901.

[10] Matar ZS. Laparoscopic adjustable gastric banding in a morbidly obese patient with situs inversus totalis. Obes Surg.2008; 18: 1632-35.

[11] Taskin M, Zengin K, Ozben V. Concomitant laparoscopic adjustable gastric banding and laparoscopic cholecystectomy in a super-obese patient with situs inversus totalis who previously underwent intragastric balloon placement. Obes Surg.2009; 19: 1724-26.

[12] Pauli EM, Wadiwala II, Rogers AM. Laparoscopic placement of an adjustable gastric band in a super- super obese patient with situs inversus. Surg Obes Relat Dis.2008; 4:768-69.

[13] Yazar FM, Emre A, Akbulut S, Urfalıoğlu A, Cengiz E, Sertkaya E, Yıldız H, Bülbüloğlu E. Laparoscopic Sleeve Gastrectomy in Situs Inversus Totalis: A Case Report and Comprehensive Literature Review. Indian J Surg.2015; 25:154-68.

Citation: Taha M H, El berry M, Al Emadi M A. Laparoscopic Sleeve gastrectomy in Situs Inversus Totalis. Junior Medical Research. 2018; 1:20-23. Taha © All rights are reserved. Submit your manuscript: www.jmedicalresearch.com