Laparoscopic Adjustable Gastric Banding for Morbid Obesity in a Patient with Situs Inversus Totalis

Laparoscopic surgery with situs inversus may pose particular challenges to the surgeon. We discuss a case of undiagnosed situs inversus totalis in a morbidly obese patient undergoing laparoscopic adjustable gastric banding (LAGB). The patient was a 29-year-old male with a body mass index (BMI) of 56. There was no prior knowledge of his situs inversus totalis, which was only discovered during laparoscopy at the time of surgery. The operative challenges are discussed. LAGB was performed successfully without complication. Postoperative imaging confirmed dextrocardia and situs inversus totalis, as well as correct gastric band position. However, there has been subsequent gastric band erosion and eventual band removal. We discuss the appropriateness of LAGB in this group of patients.     

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.     

Ascending Colon Cancer with Hepatic Metastasis and Cholecystolithiasis in a Patient with Situs Inversus Totalis Without Any Expression of UVRAG mRNA: Report of a Case

Situs inversus totalis refers to an inverted position of part or all of the viscera, which represents a mirror-image of the normal location, and it is a relatively rare condition that occurs in one in 4000–8000 people in Japan. We herein report a patient demonstrating a combination of situs inversus totalis, colon cancer with hepatic metastasis, and cholecystolithiasis, who was treated surgically. We found no expression of UVRAG mRNA in our case, thus suggesting that the UVRAG gene is partly responsible for this condition.     

Laparoscopy-Assisted Distal Gastrectomy for an Early Gastric Cancer Patient With Situs Inversus Totalis

Situs inversus totalis (SIT) is a congenital condition in which there is complete right to left reversal of the thoracic and abdominal organs. This report describes laparoscopy-assisted distal gastrectomy (LADG) for an early gastric cancer patient with SIT. The preoperative diagnosis was c-stage IA (cT1a cN0 cH0 cP0 cM0). LADG with D1+ dissection and Billroth-I reconstruction was successfully performed by standing at the opposite position. The operating time was 234 minutes and blood loss was 5 mL. Although a mechanical obstruction occurred after surgery, the patient recovered after re-operation with Roux-en-Y bypass.     

Situs Inversus Totalis with Malignant Lymphoma of the Stomach: Report of a Case

Situs inversus totalis is a rare congenital anomaly that often occurs concomitantly with other disorders. We report a case of situs inversus totalis with malignant lymphoma of the stomach, which was successfully treated by surgery followed by chemotherapy and irradiation. The patient was a 51-year-old woman who present with colicky pain in the left upper quadrant of her abdomen. Chest X-ray showed a right-sided heart, and ultrasonography and computed tomography (CT) of the abdomen showed a situs inversus totalis with multiple gallstones in the gallbladder. Tree-dimensional reconstructed CT of the abdomen showed no other malformations coexisting with situs inversus totalis, but a barium upper gastrointestinal series found an inverted stomach and an elevated tumor with ulceration in the center, localized in the antrum of the stomach. First, we performed a cholecystectomy, followed by a total gastrectomy with dissection of the lymph nodes and splenectomy, and Roux-en-Y reconstruction. Histopathological examination confirmed a diagnosis of malignant lymphoma of the stomach (diffuse large B-cell type) with metastasis to the regional lymph nodes. Chemotherapy using the CHOP regimen was given three times, starting 1 month postoperatively. A follow-up CT scan showed enlargement of one lymph node around the abdominal aorta and irradiation was delivered to the area of the inverted Y in the abdomen. At the time of writing, 10 months after surgery, the patient is well with no signs of recurrence and leading a normal life. Careful preoperative assessment is very important for determining the most appropriate surgical procedure in patients with situs inversus totalis associated with a malignancy. Received: April 25, 2002 / Accepted: November 19, 2002 RID="*" ID="*" Reprint requests to: S. Murakami     

Esophageal Atresia with Tracheoesophageal Fistula Associated with Situs Inversus Totalis

Esophageal atresia with tracheoesophageal fistula with situs inversus totalis is an extremely rare association. We are presenting a case of a preterm neonate suffering from similar condition. Fistula ligation with primary repair was done via left thoracotomy to avoid technical difficulties. Preoperative echocardiography should be done to confirm dextrocardia and disposition of the aortic arch.     

Laparoscopic hemicolectomy for a patient with situs inversus totalis: A case report

IntroductionSitus inversus totalis (SIT) is a rare congenital anomaly in which the left and right aspects of the thoracic and intra-abdominal organs are inverted, like a mirror image. Surgical procedures in a patients with SIT is difficult as their anatomy is abnormal. In particular, laparoscopic procedures are considered more difficult in patients with SIT because of the mirror-image anatomy.Presentation of caseThe patient was a 75-year-old woman with ascending colon cancer. Laparoscopic hemicolectomy with radical lymphadenectomy was performed. After surgery, no specific complications developed. On the ninth postoperative day, the patient was discharged from our hospital. Recognition of the inverted anatomy by the surgeon using preoperative imaging permitted safe operation using techniques not otherwise differing from those used in ordinary cases.Discussion and conclusionsLaparoscopic colectomy is considered to be a safe and feasible option for patients with colorectal cancer and SIT.     

Laparoscopic Cholecystectomy in a Patient with Situs Inversus

Laparoscopic cholecystectomy is one of the most common laparoscopic surgical procedures in the world today and has become the standard procedure for the treatment of gallstone disease. Symptomatic cholelithiasis in a patient with situs inversus can give rise to a diagnostic dilemma and calls for modification of the operative approach. We report one such case outlining how the diagnosis was made and describing the pitfalls encountered during surgery and how they were overcome.     

Laparoscopic Adrenalectomy for Isolated Adrenal Metastasis

Background Use of laparoscopy for isolated adrenal metastases is controversial. The aims of this study were to characterize patients with isolated adrenal metastases; compare operative characteristics of the laparoscopic adrenalectomy (LA) versus open adrenalectomy (OA) approach; and compare long-term oncological and surgical outcomes. Methods Our adrenal resection database (1995–2006) identified 63 OA and 31 LA cases done for isolated adrenal metastases. Subset analysis was performed for all patients from isolated lung metastases (n = 39) and for all tumors smaller than 4.5 cm (n = 49). Results Overall, local recurrence was 17%, median survival 30 months and 5-year estimated survival 31%. The only independent predictor of survival for all (n = 94) was adrenal tumor size less than 4.5 cm (P = 0.01). When comparing LA with OA, no differences in local recurrence, margin status, disease-free interval or overall survival were observed for the entire group, or for patients with metastases only from lung cancer (n = 39) or for those with tumors smaller than 4.5 cm (n = 49). LA provided significantly shorter operative time (175 vs 208 min, P = 0.04), lower estimated blood loss (EBL) (106 vs 749 cc, P < 0.0001), shorter length of hospital stay (2.8 vs 8.0 days, P < 0.0001) and fewer total complications (P < 0.0001). Conclusions LA is equivalent to OA in terms of margin status, local recurrence, disease-free interval and overall survival. LA for metastatic adrenal lesions is safe, with equivalent long-term oncological outcomes providing the additional benefits of a minimally invasive technique. LA can be recommended as an appropriate initial approach for isolated adrenal metastases.     

Laparoscopic Appendicectomy in a Patient with Situs Inversus Totalis

Situs inversus totalis (SIT) is a rare condition with a genetic predisposition, wherein organs or organ systems are transposed from their normal sites to locations on the opposite side of the body (the mirror image of normal). The syndrome may include transposition of the thoracic viscera, the abdominal viscera, or more commonly, both. The incidence has been calculated variously as 1 in 6,000–35,000 live births. We present the case of a 22-year-old man with SIT with acute appendicitis. Patient was treated with laparoscopic appendicectomy which is invaluable in both diagnosis and treatment of such patients.     

Laparoscopic Roux-en-Y Gastric Bypass in a Patient with Situs Inversus

We report the case of a morbidly obese patient with situs inversus totalis presenting for laparoscopic Roux-en-Y gastric bypass (RYGBP). The operative technique is detailed and we recommend the use of a mirror image approach to all parts of the operation. Consequently, the operative time is only moderately longer than usual. Laparoscopic RYGBP can be safely performed in patients with situs inversus.     

Laparoscopic hemicolectomy in a patient with situs inversus totalis after open distal gastrectomy

Situs inversus totalis(SIT) is a rare anomaly in which the abdominal and thoracic cavity structures are opposite their usual positions.Occasionally,a few patients with a combination of this condition and malignant tumors have been encountered.Recently,several laparoscopic operations have been reported in patients with SIT.We report a case of an 83-year-old man with situs inversus totalis who developed colon cancer after open distal gastrectomy.Laparoscopic hemicolectomy with radical lymphadenectomy in such a patient was successfully performed by careful consideration of the mirror-image anatomy.Techniques themselves was not different from those in ordinary cases.Thus,curative laparoscopic surgery for colon cancer in the presence of situs inversus totalis is feasible and safe.     

Laparoscopic cholecystectomy in a patient with situs inversus totalis: feasibility and technical difficulties.

Situs inversus is a rare anomaly characterized by transposition of organs to the opposite side of the body. In patients with this anomaly, cholelithiasis is observed with a frequency similar to that in the normal population. Herein, we report on a patient with situs inversus totalis who underwent laparoscopic cholecystectomy for mucocele of the gallbladder. Diagnostic pitfalls and technical difficulties of the operation with technical options are discussed in the context of the available literature. Difficulty is encountered particularly in skeletonizing the structures in Calot's triangle, which consumes extra time and is more demanding than in patients with a normally located gallbladder. A summary of an additional 32 similar cases reported in the medical literature is also presented.     

Laparoscopic surgery in situs inversus: a literature review and a report of laparoscopic sigmoidectomy for diverticulitis in situs inversus

Background Situs inversus (SI) is a rare autosomal recessive congenital defect in which the position of abdominal and/or thoracic organs is a mirror image of the normal one, in the sagittal plain. In 25% of these cases, SI is part of the Kartagener syndrome, together with bronchiectasis and chronic sinusitis.Methods We present a case of a patient with Kartagener syndrome and complete SI that was laparoscopically operated on for diverticulitis. We also review the published English information available on this rare condition.Results A review of the literature revealed another single case of laparoscopic sigmoidectomy and 27 cases of other laparoscopic interventions in the presence of SI. Those laparoscopic procedures included basic procedures such as explorations and cholecystectomies, as well as advanced procedures such as gastrectomy and gastric bypass.Conclusion The laparoscopic approach is feasible in cases of SI, although technically more complicated because of the different position of the organs and the different laparoscopic view of the anatomy.     

Laparoscopic cholecystectomy in situs inversus totalis: Feasibility and review of literature

INTRODUCTIONSitus inversus totalis is a rare anomaly characterized by transposition of organs to the opposite site of the body. Laparoscopic cholecystectomy in those patients is technically more demanding and needs reorientation of visual-motor skills to left upper quadrant.PRESENTATION OF CASEHerein, we report a 10 year old boy presented with left hypochondrium and epigastric pain 2 months duration. The patient had not been diagnosed as situs inversus totalis before. The patient exhibit a left sided “Murphy's sign”. Diagnosis of situs inversus totalis was confirmed with ultrasound, computerized tomography (CT) and magnetic resonant image (MRI) with presence of multiple gall bladder stones with no intra or extrabiliary duct dilatation. The patient underwent laparoscopic cholecystectomy for cholelithiasis.DISCUSSIONFeasibility and technical difficulty in diagnosis and treatment of such case pose challenge problem due to the contra lateral disposition of the viscera. Difficulty is encountered in skelatonizing the structures in Calot's triangle, which consume extra time than normally located gall bladder. A summary of additional 50 similar cases reported up to date in the medical literature is also presented.CONCLUSIONLaparoscopic cholecystectomy is feasible and should be done in situs inversus totalis by experienced laparoscopic surgeon, as changes in anatomical disposition of organ not only influence the localization of symptoms and signs arising from a diseased organ but also imposes special demands on the diagnosis and surgical skills of the surgeon.     

Laparoscopic appendectomy in a female patient with situs inversus: case report and literature review.

BACKGROUND: Situs inversus is an uncommon condition caused by a single autosomal recessive gene of incomplete penetration. A potential diagnostic dilemma can occur in the young female patient with a history of situs inversus who presents with pelvic pain. METHODS: A 32-year-old multiparous patient with a known history of situs inversus presented with complaints of pelvic pain. A medical history and full physical examination were indicative of possible endometriosis. RESULTS: The patient underwent an operative laparoscopy, which revealed stage II pelvic endometriosis based on the American Fertility Society Revised Classification for Endometriosis (R-AFS), with appendicular and periappendicular adhesions involving the cecum. Ablation of endometriosis and an appendectomy were performed. CONCLUSION: The authors believe the laparoscopic approach to an appendectomy is ideal in a patient with situs inversus and should be performed at the time of laparoscopy performed for another reason.     

Laparoscopic Sleeve Gastrectomy for a Super-Super-Obese Patient with Situs Inversus Totalis

Situs inversus totalis is a rare defect which can present difficulties in the management in laparoscopic surgery due to the mirror-image anatomy. Herein, we report a patient with situs inversus totalis and super-super-obesity (BMI 76 kg/m²). We performed successful laparoscopic sleeve gastrectomy. Technical details of this operation, with situs inversus totalis, are presented. There were no major difficulties compared to patients with usual anatomy. There are potential diseases associated with situs inversus and obesity; therefore, a careful investigation, including a chest x-ray and cardiac and abdominal ultrasounds should be performed before surgery. Sleeve gastrectomy is an adequate procedure in super-super-obese patients with situs inversus totalis.     

Hepatic Resection for Metastatic Colon Cancer in Patients with Situs Inversus Totalis Complicated by Multiple Anomalies of the Hepatobiliary System: The First Case Report

Background  Situs inversus totalis is a rare condition characterized by a mirror-image transposition of the abdominal and thoracic viscera. In order to develop safe techniques for hepatic resection, it is important to report surgical outcomes in cases complicated by situs inversus totalis and other anomalies. Case  The patient was a 64-year-old man with situs inversus totalis who had previously undergone sigmoidectomy with regional lymphadenectomy for sigmoid colon cancer at age 62. Despite postoperative adjuvant chemotherapy, tumor markers increased and multiple liver metastases were detected on abdominal ultrasonography. Enhanced computed tomography revealed not only liver metastases but also hepatobiliary anomalies associated with situs inversus totalis as follows: (1) portal vein located anterior to the common bile duct or hepatic artery, (2) proper hepatic artery arising from the superior mesenteric artery, (3) “left” (right in normal population)-sided umbilical portion of the portal vein and total ramification of intrahepatic portal branches from that point, (4) hepatic vein directly communicating to the “left” atrium. For the treatment of hepatic metastases from sigmoid colon cancer in a patient with situs inversus totalis, “left” hepatic lobectomy, partial hepatectomy, and radiofrequency ablation therapy were performed. The postoperative course was uneventful. Adjuvant chemotherapy has been continued for 2 years after the second operation and the patient is doing well without recurrence. Conclusion  Since situs inversus totalis is occasionally accompanied by multiple hepatobiliary anomalies, careful evaluation of the related anatomy using modern imaging modalities is crucial for safe hepatic resection.