Laparoscopic Sleeve Gastrectomy in Patients with Situs Inversus

Situs inversus is a congenital condition in which the major visceral organs are reversed or mirrored from their normal positions. Situs inversus is found in about 0.01% of the population. In the most common situation, situs inversus totalis involves complete transposition (right to left reversal) of all of the abdominal organs. Several successful and safe laparoscopic weight loss surgeries were previously reported in morbidly obese patients with situs inversus (Aziret et al. Obes Res Clin Pract. 32;11(5S1):144-51, 2017; Catheline et al. Obes Surg.;16(8):1092-5, 2006).

We present a case of a 47-year-old female patient with a BMI of 51 kg/m², who was referred to our clinic for the treatment of morbid obesity. Her past medical history included hypertension, type II diabetes mellitus, asthma, and situs inversus. During the preoperative evaluation, the chest x-ray showed dextrocardia and upper GI series showed the stomach and duodenum in a mirror position.

The operative time was 62 min, oral intake started on postoperative day 1, and the patient was discharged on postoperative day 2 in good medical condition.

Situs inversus is a rare condition that can be challenging for a laparoscopic surgeon. LSG is feasible and safe for morbidly obese patients with this anomaly. Well understanding of the mirrored image anatomy will facilitate the performance of the procedure without special difficulties by an experienced surgeon.