Background

Bariatric surgery is becoming increasingly commonplace in treating morbid obesity and its associated co-morbidities, with over 260,000 cases performed annually according to the ASMBS. Not infrequently, these procedures are performed on patients with unique conditions requiring a thorough workup. Situs inversus totalis (SIT) represents a rare anatomical deviation (0.01% prevalence) with thoracic and abdominal viscera being in mirror-image positions from normal anatomy. The rarity of this condition underscores the need for this report, as understanding the preoperative work up and unique technical challenges will help surgeons better prepare for such cases.

Methods

A case study is presented of a 54-year-old female with morbid obesity, BMI of 49, Obstructive Sleep Apnea, cardiac arrythmias (with AICD implantation), and known Situs inversus totalis. She presented to our office with complaints of regurgitation and weight regain 7 years after having a sleeve gastrectomy at another facility.

Results

After appropriate preoperative work up, she was offered a conversion to gastric bypass. A video of a robotic gastric sleeve to gastric bypass conversion is presented. At her 1-month follow up visit, she was doing well with a BMI of 47, tolerating her diet and compliant on medications and vitamins.

Conclusions

We conclude that bariatric surgery is safe in patients with situs inversus provided that all preoperative workup is done, and necessary anatomical precautions are taken during the procedure.