Laparoscopic Adjustable Gastric Banding in a Morbidly Obese Patient with Situs Inversus Totalis

Laparoscopic adjustable gastric banding is a commonly performed bariatric operation worldwide. The presence of an anatomical variation like situs inversus demands preoperative assessment and preparedness on the part of the surgeon. We report a laparoscopic gastric banding performed on a morbidly obese patient with situs inversus totalis in the Kingdom of Saudi Arabia.     

Emergency Sleeve Gastrectomy as Rescue Treatment for Acute Gastric Necrosis Due to Type II Paraesophageal Hernia in an Obese Woman with Gastric Banding

A morbidly obese 42-year-old woman presented with a 1-week history of left chest pain. She had undergone laparoscopic adjustable gastric banding 16 months earlier with a body mass index (BMI) of 49.2 kg/m². Diagnostic workup revealed a large left pleural empyema and ruled out band slippage. At left thoracotomy, a misdiagnosed type II paraesophageal strangulated hernia with gastric necrosis and large perforation of the fundus was evident. At laparotomy, the band was removed, the stomach was reduced into the abdomen, and a sleeve gastrectomy was performed. Her postoperative course was uneventful, and 6 months after surgery, her BMI is 31 kg/m². Emergency sleeve gastrectomy could represent a good option to treat, at the same time and in a safe way, both gastric necrosis and paraesophageal hernia, improving the good results in terms of weight loss after gastric restriction from gastric banding.