Concomitant Laparoscopic Adjustable Gastric Banding and Laparoscopic Cholecystectomy in a Super-Obese Patient with Situs Inversus Totalis Who Previously Underwent Intragastric Balloon Placement

Abstract

Laparoscopic adjustable gastric banding has been increasingly performed since its introduction in 1990. Situs inversus totalis is a rare anomaly in which transposition of organs to the opposite side of the body occurs. Laparoscopic gastric banding in such few patients has been reported in the literature. We discuss a super-obese patient with situs inversus totalis and asymptomatic cholelithiasis who previously underwent endoscopic intragastric balloon placement in preparation for bariatric surgery. Afterwards, laparoscopic cholecystectomy and laparoscopic adjustable gastric banding were performed in the same session. Special attention is paid to the literature review and the mirror-image modification of the laparoscopic cholecystectomy and laparoscopic gastric banding procedures. With preoperative assessment, modifications in the surgical team, and equipment, the operation can be performed safely.

Laparoscopic Sleeve Gastrectomy in Situs Inversus Totalis: a Case Report and Comprehensive Literature Review

“…Since the first case reported in 1998, there have been 12 further publications in English of cases where laparoscopic surgery was performed [7]. These comprised four patients who underwent LRYGB [5,[7][8][9], four LSG [9][10][11][12] (one case of SILS+LSG [12]), and five LAGB [13][14][15][16][17]. One article included two patients [9], and all the other publications were each of a single case.…”

“…However, the most emphasized method is abdominal ultrasonography (USG) ordered in the preoperative period. USG is not only for the diagnosis of SIT but can also detect additional pathologies such as incidentally identified gall bladder stones in patients [9,15,16]. Another diagnostic method that can be used is endoscopy.…”

“…The establishment of diagnosis preoperatively may be helpful not only for the prevention of pulmonary and cardiac complications that may accompany the disease or which may develop in the postoperative period, but also for the avoidance of improper incisions and technical challenges. Taşkın et al emphasized that awareness of the surgical terms about the anatomical variation leads to the ability to prepare preoperatively in terms of mental and physical conditions and equipment, which in turn shortens the operational time [16]. It was found in literature that the diagnosis was made in advance in all the patients and all the equipment used was redesigned, including the monitoring systems.…”

“…Gastric banding, which used to be widely used, has been gradually replaced by gastric bypass and sleeve gastrectomy [6]. SIT is an infrequent condition, but has begun to be seen more often with an increasing number of cases reported [5,[7][8][9][10][11][12][13][14][15][16][17]. The presentation of these cases can be considered to provide benefit, especially in the reduction of complications in specific patients.…”

Roux-en-Y gastric bypass in a patient with situs inversus totalis – a case report

“…the accessory hepatic artery branching from the left gastric artery). In the published literature, there have been only 5 reports of laparoscopic adjustable gastric banding [17][18][19][20][21], 1 report of laparoscopic sleeve gastrectomy [22] and 2 reports of laparoscopic Rouxen-Y gastric bypass [23,24] in patients with situs inversus. Atypical organ orientation may be a problem for a laparoscopic surgeon and in that case a minimally invasive procedure requires more technical and mental preparation of the surgeon and staff of the operating theatre.…”