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Obesity Surgery

, Volume 28, Issue 9, pp 2987–2987 | Cite as

Laparoscopic Sleeve Gastrectomy in Patients with Situs Inversus

  • Dvir FroylichEmail author
  • Tamar Segal-Abramovich
  • Guy Pascal
  • David Hazzan
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Abstract

Background

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).

Methods

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.

Results

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.

Conclusions

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.

Keywords

Bariatric surgery Sleeve gastrectomy, situs inversus Morbid obesity Laparoscopy 

Notes

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Supplementary material

11695_2018_3383_MOESM1_ESM.mp4 (115.6 mb)
The patient was placed in a semi-lithotomy position. Four 12 mm and one 5 mmports were used. We preferred using more 12 mm trocars to enable an optimal optical view and optimal angles for the stapler A Nathanson retractor retracted the left-lobe of the liver. Inspection of the abdomen showed the stomach on the right side and the gallbladder on the left. Dissection started on the greater curvature, using the harmonic scalpel. We proceeded towards the angle of his, dividing the short-gastric vessels. In-contrast to a regular case, the surgeon retract the stomach with his right hand, and dissect with the harmonic scalpel with his left hand. Last attachments are divided and the right crus is identified. The fat-pad is partially dissected. The dissection is continued downwards towards the pylorus. The pylorus is identified and division of the vessels was stopped 3 cm proximal to it.A 42 F bougie was used for calibration of the gastric tube. We used this size as a standard for all our cases based on a study that reported association of smaller size bougies with a higher leak rates. A 60 mm linear stapler was used to divide the stomach. We used a green load followed by gold and then blue cartridges.The proximal stapled-line was reinforced with a running 2.0 prolene. A Jackson-Pratt drain was placed along the stapled-line. The specimen was removed through the supra umbilical incision. The operation time was 62 minutes; Estimated blood loss was 5 cc. (MP4 118350 kb)

References

  1. 1.
    Aziret M, Karaman K, Ercan M, et al. Laparoscopic sleeve gastrectomy on a morbidly obese patient with situs inversus totalis: a case study and systematic review of the literature. Obes Res Clin Pract. 2017;11(5S1):144–51.CrossRefGoogle Scholar
  2. 2.
    Catheline JM, Rosales C, Cohen R, et al. Laparoscopic sleeve gastrectomy for a super-super-obese patient with situs inversus totalis. Obes Surg. 2006;16(8):1092–5.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Surgery B DepartmentCarmel Medical CenterHaifaIsrael

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