A patient with Situs Inversus Totalis who underwent Laparoscopic Sleeve Gastrectomy: a case report

doi:10.21203/rs.3.rs-2588022/v1

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Case Report

A patient with Situs Inversus Totalis who underwent Laparoscopic Sleeve Gastrectomy: a case report

https://doi.org/10.21203/rs.3.rs-2588022/v1

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Introduction Obesity is associated with several preventable health issues, such as diabetes mellitus and hypertension. Bariatric surgery has shown potential treating obesity. Laparoscopic sleeve gastrectomy (LSG) is one of the several bariatric surgical techniques that is gaining popularity as primary bariatric surgery. Situs Inversus Totalis (SIT) is an uncommon hereditary abnormality that can make laparoscopic surgery challenging due to the anatomy's mirror-image aspect.

Case report We present the case of a 54-year-old female, BMI was 54.36 kg/m². She was diagnosed with Situs Inversus Totalis, with no other known diseases, drug intake, or allergies. We performed a conventional laparoscopic gastric sleeve modifying the original trocar ports positions like a mirror to match the anatomy.

Conclusion Laparoscopic gastric sleeve is a safe and effective procedure for patients with Situs Inversus Totalis. Preoperative diagnosis can help lower the risk of complications by having a proper surgical plan.

Laparoscopic Sleeve Gastrectomy

Situs Inversus

Bariatric Surgery

Obesity.

Obesity is becoming a significant public health problem [1]. Obesity is associated with various potentially preventable health issues, such as diabetes mellitus and hypertension [2]. Bariatric surgery has shown potential treating obesity. Laparoscopic sleeve gastrectomy (LSG) is one of the several bariatric surgical techniques that is gaining popularity as primary bariatric surgery. Additionally, it has been demonstrated that these treatments have preventive benefits against metabolic syndrome, including diabetes mellitus, cancer incidence, and sometimes even survival [3, 4].

Situs inversus totalis (SIT) is an uncommon hereditary abnormality that can make laparoscopic surgery challenging due to the anatomy's mirror-image aspect [4]. SIT is an uncommon autosomal recessive disease that affects 0.005–0.02% of humans. Complete intra-abdominal organ transposition is implicated. Most individuals with SIT do not have any symptoms or consequences because the way the organs interact remains unchanged [5].

We present the case of a 54-year-old female residing in the United States of America who was scheduled for the gastric sleeve at our hospital. The patient's height was 1.57 m, weight was 134 kg, and BMI was 54.36. She had a surgical history of cholecystectomy in adolescence. She was also diagnosed with Situs Inversus Totalis, with no other known diseases, drug intake, or allergies. She reported having followed multiple exercise and diet regimens for years without any success in losing weight. She also reported having used Phentermine for the same purpose. Since she was diagnosed with Situs Inversus Totalis years ago, our team was prepared for this clinical situation before her arrival. Preoperative and laboratory evaluations fell within the expected normal parameters. Dextrocardia was observed on the chest X-ray.

We performed a conventional laparoscopic gastric sleeve modifying the original trocar ports positions like a mirror (Fig. 1) to match the anatomy. We used a 36 Fr orogastric tube as a guide performing the gastric sleeve (Fig. 2). The staple line was transfective as reinforcement, the trans-surgical pneumatic test was performed to discard any leak, total bleeding of 10 ml, surgical time of 45 min, and a Penrose drainage was placed. The patient's prognosis was favorable.

After the surgery, the patient's recovery was without any complications, as expected. We used a conventional analgesic and antiemetic regimen with ketorolac/paracetamol and ondansetron, respectively. The patient resumed oral intake generally after 5 hours of her surgery with a liquid diet and resumed walking 6 hours after surgery with no incident. At 24 hours, we performed a control fluoroscopy with no alterations, and the drain was removed with 20 mL of serohematic expenditure. She was discharged 48 hours after her surgery with no complications.

This case report describes a patient who underwent gastric sleeve surgery with a history of Situs Inversus Totalis previously diagnosed. SIT is a rare condition. Therefore, surgeons treating many patients should estimate seeing it once or twice throughout their career [6]. Since bariatric surgery is one of the most effective treatments for treating obesity, it is anticipated that more patients will choose it in the upcoming years. As a result, more patients will arrive with SIT, either as an existing condition or as an unexpected discovery during the presurgical evaluation. In these individuals, laparoscopic gastric sleeve surgery is an effective and safe technique [7].

Few Situs Inversus cases in bariatric surgery have been reported over the years [6]. It is essential to know if our patients have these kinds of alterations. Although SIT does not represent a severe health condition, proper surgical planning can help lower the risk of complications [8].

There are no guidelines that describe the proper approach for these patients. Therefore the surgeon and surgical team must be capable of adapting the classic techniques we describe in our case. We decided to modify the trocar port positions as a mirror image to better approach the patient's abdominal cavity.

The average surgical time for gastric sleeve surgery reported in the literature is up to 120 minutes. Despite the patient's anatomical irregularities in this case, our surgery time was below the reported; however, the surgeon's experience may have contributed to this.

It has been demonstrated that laparoscopic gastric sleeve is a safe and effective procedure on patients with abnormal anatomies such as SIT, and it should be considered as a treatment option when other less invasive methods have failed, as long as the surgeon can be able to adapt the surgical techniques depending on every clinical scenario.

Laparoscopic gastric sleeve is a safe and effective procedure for patients with Situs Inversus Totalis. Despite its rarity, surgeons with high patient volumes must be prepared and aware of this condition. Preoperative diagnosis can help lower the risk of complications by having a proper surgical plan.

Funding Declaration

We declare no sources of funding.

Conflict of interest

We declare no conflict of interest.

Authors’ contributions All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by HJ. Pérez, JA. Guzmán, I. Esparza, JA. Barriga, and FJ. Quero. The first draft of the manuscript was written by RE. Salgado, JS. Verboonen, J. Romero and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Compliance with ethical standards

Conflict of interest. The authors declare that they have no conflict of interest.

Consent to publish. The patient has consented to the submission of the case report to the journal.

Amirbeigi A, Abbaslou F, Elyasinia F (2022) Laparoscopic sleeve gastrectomy in a patient with Situs Inversus Totalis: A case report and literature review. Ann Med Surg (Lond). 29(79):104101. https://doi.org/10.1016/j.amsu.2022.104101
Finkelstein EA, Trogdon JG, Cohen JW, et al. (2009) Annual medical spending attributable to obesity: payer-and service-specific estimates. Health Aff (Millwood). 28(5) w822–w831. https://doi.org/10.1377/hlthaff.28.5.w822
Fischer L, Hildebrandt C, Bruckner T, et al. (2012) Excessive weight loss after sleeve gastrectomy: a systematic review, Obes Surg. 22(5): 721–731. https://doi.org/10.1007/s11695-012-0616-1
Catheline JM, Rosales C, Cohen R, et al. (2006) Laparoscopic sleeve gastrectomy for a super-super-obese patient with situs inversus totalis. Obes Surg. 16(8):1092–5. https://doi.org/10.1381/096089206778026352
Atwez A, Keilani Z. (2018) Laparoscopic Roux-en-Y gastric bypass in a patient with situs inversus totalis: Case report, technical tips and review of the literature. Int J Surg Case Rep. 45:56–62. https://doi.org/10.1016/j.ijscr.2018.03.004
Samaan M, Ratnasingham A, Pittathankal A, et al. (2008) Laparoscopic adjustable gastric banding for morbid obesity in a patient with situs inversus totalis, Obes. Surg. 18: 898–901. https://doi.org/10.1007/s11695-008-9445-7
Burvill A, Blackham R, Hamdorf J, (2019) Laparoscopic sleeve gastrectomy in a patient with situs inversus totalis and Kartagener syndrome: An unusual surgical conundrum, BMJ Case Rep. 12: e229550. http://dx.doi.org/10.1136/bcr-2019-229550
D. Froylich, T. Segal-Abramovich, G. Pascal, D. Hazzan, (2018) Laparoscopic sleeve gastrectomy in patients with situs inversus, Obes. Surg. 28: 2987. https://doi.org/10.1007/s11695-018-3383-9

No competing interests reported.

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A patient with Situs Inversus Totalis who underwent Laparoscopic Sleeve Gastrectomy: a case report

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