Abstract
•Laparoscopic surgery in patients with situs inversus is technically challenging especially in morbid obese patients.•This morbid obese patient underwent an uneventful laparoscopic bilio-pancreatic diversion.•Any bariatric procedure can be done safely in morbid obese patients with situs inversus by an experienced bariatric surgeon in a specialized center.
Situs inversus is a rare congenital anomlay in which the thoracic and abdominal organs are sited on the opposite side to that of normal anatomy. Its etiology is still unknown. It is classified into situs inversus partialis and situs inversus totalis. It is discovered incidentally in most cases. Any surgical intervention for such patients may encounter intra-operative technical difficulties due to anatomical differences, particularly if a laparoscopic approach is adopted, as in bariatric surgeries where the obesity itself opposes an added surgical challenge.
A female patient with a BMI of 52.1 Kg/m2 was being prepared for biliopancreatic diversion. She was diagnosed incidentally as having situs inversus totalis during the preoperative evaluation. She underwent an uneventful laparoscopic biliopancreatic diversion. She was followed up regularly in the bariatric surgery clinic for 9 years. Her last BMI was 29 Kg /m2 with no signs or symptoms of metabolic complications.
This case report demonstrates that biliopancreatic diversion can be done safely in morbidly obese patients with situs inversus by an experienced bariatric surgeon in a specialized well-equipped center.