Routine Bariatric Surgery with Unfamiliar Anatomy: Gastric Bypass in the Setting of Situs Inversus

Document Type

Conference Proceeding

Publication Date

4-2025

Publication Title

Surgical Endoscopy

Abstract

In patients with Situs Inversus, intra-abdominal organs are in a reversed configuration in combination with the heart situated in the right thorax. This reversed alignment does not cause alteration in organ function. Severe obesity (class III) involves a BMI[40 and is a disease process that continues to rise in prevalence. Among US adults, the prevalence of severe obesity almost doubled from 2000 (4.7%) to 2018 (9.2%). Weight loss surgery has shown to be an effective means of weight loss with low levels of morbidity and complications. We present a case of a 40-year-old female with history of hypertension, kartageners, and morbid obesity. Her preoperative weight was 232 pounds (BMI 40.5 kg/m2 ). She underwent a laparoscopic gastric bypass with a standard 100 cm roux limb and 50 cm biliopancreatic limb configuration. In this case, the procedure was performed by flipping trochar placement with regard to right and left orientation and with the surgeon standing on the patient’s left side. Opposite hands were used for each instrument and to complete each step of the procedure. Due to the altered anatomy, the procedure took an extra 45 min in part to confirm the proper orientation of all the anastomoses (180 min vs 120 min). The operation was performed without complication and at an 11-month postoperative visit, she had lost 79 pounds (BMI 26.7 kg/m2 ). In conclusion, Situs Inversus presents a unique challenge for a bariatric surgeon, especially in performing a bypass requiring two separate anastomosis. Standard trochar placement/technique with a mirror image configuration is a safe method for completing this operation.

Volume

39

Issue

Suppl 1

First Page

S229

Comments

SAGES Annual Meeting, March 12–15, 2025, Long Beach, CA

Last Page

S229

DOI

10.1007/s00464-025-11690-9

ISSN

1432-2218

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