Laparoscopic sleeve gastrectomy in a patient with situs inversus totalis and Kartagener syndrome: an unusual surgical conundrum

Finding of situs inversus in endoscopic sleeve gastroplasty: Case report

INTRODUCTION AND IMPORTANCE

Situs inversus is an anatomical rare condition in which visceral organs are not located in its normal position, with a reversal anatomical orientation.

CASE PRESENTATION

We present a case of an 27-year-old male with a Body Mass Index (BMI) of 36.02 Kg/m2, who was programed for a Endoscopic Sleeve Gastroplasty (ESG), in which Situs inversus was documented.

CLINICAL DISCUSSION

Situs inversus is an uncommon anatomical condition that complicates identifying surgical landmarks and performing procedures like ESG. Preoperative imaging, such as abdominal ultrasound or computed tomography, is critical for confirming the diagnosis and planning the intervention. In this case, ESG was successfully executed using standard techniques, emphasizing the importance of expertise and careful planning. The reversed anatomy required adjustments in endoscopic navigation but did not necessitate major deviations from established protocols. This case highlights that, under the care of experienced endoscopists, ESG remains a safe and effective option for patients with situs inversus.

CONCLUSION

Situs inversus is rare anatomical variation that can represent a challenge in bariatric endoscopic procedures such as ESG. Nevertheless, ESG can be safely performed under an experienced endoscopic bariatric surgeon.

Laparoscopic Sleeve Gastrectomy in Situs Inversus Totalis: A Case Report

Obesity prevalence is increasing with the modern lifestyle. Bariatric surgery is an excellent method to sustain weight reduction and the most commonly performed surgery is laparoscopic sleeve gastrectomy (LSG). The laparoscopic approach can be challenged in certain conditions such as situs inversus totalis (SIT). We report a 38-year-old gentleman with class II obesity known to have SIT. After complete preoperative preparation, we performed LSG with no complications. The main difficulty of performing any surgical procedure for SIT patients is the reversed anatomy. It is essential to highlight the importance of anatomy for surgeons. Proper preoperative anatomy assessment along with the surgeon's experience is the key element to perform LSG or any bariatric laparoscopic procedure in rare conditions such as SIT.

Bariatric and Metabolic Surgery in Patients with Situs Inversus: a Systematic Review

Laparoscopic surgery in patients with obesity with situs inversus (SI) may pose interesting challenges to diagnosing and managing due to the mirror image anatomy. Since in SI patient's organs are displaced, the surgery requires high levels of precision and hand-eye coordination. SI and bariatric surgery may pose challenges for the surgical team. A total of 46 patients were reported in this systematic review. The mean age of cases was ~39 years (range 19-59), and the mean BMI was 45.9 kg/m2 (range 35-76). Of the included 46 patients, 39 had SIT. In the majority of the included patients, either a laparoscopic Roux-en-Y gastric bypass (LRYGB) (in 15 patients (35%)) or a laparoscopic sleeve gastrectomy (LSG) (in 21 patients (45.6%)) was performed. Complications were documented in 3 cases.

Laparoscopic Sleeve Gastrectomy (LSG) in a Patient With Situs Inversus Totalis (SIT): A Case Report

Obesity is associated with several preventable health issues, such as diabetes mellitus and hypertension. Bariatric surgery has shown potential in treating obesity. Laparoscopic sleeve gastrectomy (LSG) is one of several bariatric surgical techniques gaining popularity as a primary procedure. Situs inversus totalis (SIT) is an uncommon hereditary abnormality that can present challenges in laparoscopic surgery due to the mirror-image anatomy. We present the case of a 54-year-old female with a body mass index (BMI) of 54.36 kg/m². She was diagnosed with SIT and had no other known diseases, medication use, or allergies. We performed a conventional LSG, modifying the original trocar port positions to match the anatomy. LSG is a safe and effective procedure for patients with SIT. Preoperative diagnosis can help reduce the risk of complications by facilitating proper surgical planning.

Laparoscopic sleeve gastrectomy in situs inversus totalis: a case report

Obesity and being overweight are defined as abnormal and excessive fat accumulation, respectively. Obesity is defined as a BMI of 30 or higher. Sleeve gastrectomy, the most commonly performed bariatric surgery worldwide, is an effective treatment for obesity and its comorbidities. However, some cases, such as situs inversus, may present additional challenges for surgeons.

Case Presentation

The authors present the case of a 28-year-old female scheduled for gastric sleeve surgery with a BMI of 49. During the preoperative evaluation, dextrocardia was evident, and a diagnosis of situs inversus totalis was made. The surgery was performed without complications in a high-volume hospital specializing in bariatric surgery.

Clinical Discussion

Gastric sleeve surgery should be considered an effective and safe procedure in such patients as long as the surgeon is prepared, makes technical adjustments with their team, and has the necessary experience.

Conclusion

Laparoscopic gastric sleeve surgery is a safe procedure in patients with situs inversus, as long as it is performed by an experienced surgeon.

Da Vinci robot-assisted pancreato-duodenectomy in a patient with situs inversus totalis: A case report and review of literature

BACKGROUND

Situs inversus totalis (SIT) is an extremely rare congenital malformation characterized by mirror displacement of the thoracoabdominal organs such as the heart, liver, spleen, and stomach. Herein, we describe a patient with SIT complicated with cholangiocarcinoma who underwent successful pancreaticoduodenectomy with the assistance of a da Vinci robot.

CASE SUMMARY

A 58-year-old female presented to the hospital with paroxysmal pain in her left upper abdomen, accompanied by jaundice and staining of the sclera as chief complaints. Imaging examination detected a mass at the distal end of the common bile duct, with inverted thoracic and abdominal organs. Endoscopic retrograde cholangiopancreatography forceps biopsy revealed the presence of a well-differentiated adenocarcinoma. The patient successfully underwent robotic-assisted pancreaticoduodenectomy; the operation lasted 300 min, the intraoperative blood loss was 500 mL, and there were no intraoperative and postoperative complications.

CONCLUSION

SIT is not directly related to the formation of cholangiocarcinoma. Detailed preoperative imaging examination is conducive to disease diagnosis and also convenient for determining the feasibility of tumor resection. Robot-assisted pancreaticoduodenectomy for SIT complicated with cholangiocarcinoma provides a safe, feasible, minimally invasive, and complication-free alternative with adequate preoperative planning combined with meticulous intraoperative procedures.

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

Situs inversus (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. Diagnosis of SI is usually made incidentally while investigating for unrelated medical problem. It can be associated with cardiac and respiratory anomalies that may cause perioperative morbidity if not diagnosed before surgery. There are limited case reports in literature of SI patients that underwent bariatric procedures. We report a case of a 32-year-old female with SI partialis and levocardia who successfully underwent laparoscopic sleeve gastrectomy. We concluded that sleeve gastrectomy is safe in patients with SI if diagnosed preoperatively and if all the necessary precautions are taken into consideration before and during the surgery.

Laparoscopic sleeve gastrectomy in a patient with Situs Inversus Totalis: A case report and literature review

Introduction

& Importance: Laparoscopic sleeve gastrectomy (LSG) is a widely accepted and effective bariatric surgery for achieving weight loss in patients with extreme obesity. Performing this surgical procedure in patients with congenital anatomical changes including situs inversus (SI) is a challenge for the surgical team. In this condition, the orientation of intra-abdominal organs is the mirror image of those in normal populations.

Case presentation

Herein, we present a 29-year-old female with situs inversus totalis who successfully underwent an LSG surgery with proper weight loss post-operatively and no early and late complications.

Clinical discussion

By reviewing the literature for patients with SI undergoing the same procedure, all patients achieved significant weight loss. Three out of nineteen cases experienced complications which were controlled without significant morbidity or mortality.

Conclusion: we concluded that LSG will be a safe and effective surgery for the treatment of extreme obesity in SI patients, if the condition is diagnosed preoperatively.

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Performing laparoscopic sleeve gastrectomy (LSG) in patients with situs inversus (SI) is a challenge for the surgical team.

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SI should be diagnosed prior to surgery to avoid prolonged surgery and lack of expertise.

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LSG will be a safe and effective surgery for the treatment of extreme obesity in SI patients.

Situs inversus and bariatric surgery: A challenge for the surgical team

Introduction and Importance

Obesity is a worldwide pandemic and is closely associated with an increased risk of comorbidities and overall mortality. Surgery has emerged as an essential strategy to ameliorate obesity-attributable comorbidities and as a powerful weight-loss tool. Due to the increasing number of obese patients predicted to elect surgery, individuals with rare anomalies such as situs inversus can be expected.

Case presentation

We present the case of a 49-year-old woman with situs inversus with levocardia. She had a high BMI and was admitted for bariatric surgery. After several adjustments to our technique, the procedure was completed without complications.

Clinical discussion

Laparoscopic bariatric surgeries are highly demanding; variations from the normal anatomy could challenge the medical team.

Conclusion

Preoperative diagnosis and highly trained surgeons is of paramount importance to adequately treat every patient.

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Perioperative assessment of every patient is critical to ensure favorable results

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The experience and training of the surgical team will define the patient outcome

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Due to the increasing number of obese patients predicted to elect surgery, individuals with rare anomalies such as situs inversus can be expected

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

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.

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

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/m²) 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.