Laparoscopic sleeve gastrectomy on a morbidly obese patient with situs inversus totalis: A case study and systematic review of the literature.

INTRODUCTION: Situs inversus totalis (SIT) is a condition where the internal organs or organ systems are located contra-laterally to the norm, forming a mirror image. Laparoscopic sleeve gastrectomy (LSG) is an effective bariatric procedure that has become more common over the last two decades. We report on a morbidly obese patient with SIT who underwent a successful LSG.

CASE REPORT: A 54-year-old female morbidly obese patient (136k; 167cm; body mass index (BMI): 48kg/m2 ) was admitted for bariatric surgery. She had congenital SIT, a history of open cholecystectomy and, despite implementing the suggestions of the dietitian and endocrinologist, she had failed to lose weight. A standard LSG was performed successfully using the French method. The patient's postoperative course was uneventful and she was discharged on the 5th postoperative day. She is now in the 4th month with a weight loss of 30kg.

DISCUSSION: SIT is a rare congenital condition, occurring in 1/10,000 to 1/50,000 live births. Organ function is generally normal, although it may sometimes be accompanied by respiratory or cardiovascular anomalies. Although undertaking LSG on morbidly obese patients with SIT may seem a daunting proposition at first, experienced laparoscopic surgeons can manage this operation with success.

CONCLUSION: Although SIT is a rare congenital condition, LSG can be performed safely and effectively.