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

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Abstract

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.

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Authors and Affiliations

  1. Department of Surgery, Holy Family Hospital, Namsauy St. 1, Nazareth, Israel

    Nasser Sakran

  2. The Azrieli, Faculty of Medicine, Bar-Ilan University, Safed, Israel

    Nasser Sakran

  3. Department of Surgical Endoscopy, Sana Hospitals, Germany and Obesity Center NRW, Huerth, Germany

    Christine Stier

  4. Department of Surgery, Whittington Health NHS Trust, London, UK

    Chetan Parmar

  5. Apollo Hospitals Educational and Research Foundation, Hyderabad, India

    Chetan Parmar

  6. Department of General, Abdominal Surgery and Coloproctology, Helios St. Elisabeth Klinik, Oberhausen, NRW, Germany

    Sjaak Pouwels

  7. Department of Intensive Care Medicine, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands

    Sjaak Pouwels

  8. Faculty of Health, Witten/Herdecke University, Witten, Germany

    Sjaak Pouwels

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  1. Nasser Sakran
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  2. Christine Stier
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  3. Chetan Parmar
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  4. Sjaak Pouwels
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Contributions

Initial idea: N. S., S. P.

Literature search: N. S., S. P.

Data analysis: N. S., C. S., C. P., S. P.

Writing the manuscript: N. S., C. S., C. P., S. P.

Final approval: N. S., C. S., C. P., S. P.

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Correspondence to Nasser Sakran.

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Key Points

• Situs inversus (SI) related to obesity is a rare condition.

• Patients with SI can have BS safely but is very important to have the routine preoperative protocol.

• In order to perform this procedure safely in patients with SI, the mirror image approach has been demonstrated to be effective.

• Robotic surgery can be an option to avoid the need to change position or instrument orientation.

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Sakran, N., Stier, C., Parmar, C. et al. Bariatric and Metabolic Surgery in Patients with Situs Inversus: a Systematic Review. OBES SURG 33, 3628–3635 (2023). https://doi.org/10.1007/s11695-023-06847-1

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