Roux-en-Y Gastric Bypass in Patient with Situs Inversus Totalis
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MULTIMEDIA ARTICLE
Roux-en-Y Gastric Bypass in Patient with Situs Inversus Totalis Tigran Poghosyan 1 & Matthieu Bruzzi 1 & Claire Rives-Lange 2 & Sebastien Czernichow 2 & Jean-Marc Chevallier 1 & Richard Douard 1
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract In some cases, in addition to the usual difficulties that the bariatric surgeon may encounter during standard bariatric procedures, anatomical anomalies such as situs inversus can pose an additional technical challenge. A 58-year-old patient with total situs inversus underwent Roux-en-Y gastric bypass (RYGB) surgery in our department. The main difficulty was the realization of a mirrored RYGB. Laparoscopic RYGB in a patient with situs inversus totalis is feasible but requires significant concentration and three-dimensional coordination to perform the mirrored procedure. Keywords Roux-en-Y gastric bypass . Bariatric surgery . Situs inversus
Introduction The emergence of laparoscopy has accelerated the development of bariatric surgery. The perfect mastery of surgical techniques in bariatric surgery is essential, given the potential complications and their consequences on the patient’s life. In some cases, in addition to the usual difficulties that the bariatric surgeon may encounter during standard bariatric procedures, anatomical anomalies such as situs inversus or intestinal malrotation can pose an additional technical challenge [1]. Situs inversus totalis is a rare autosomal recessive anatomical anomaly with incidences ranging between 1/10000 and 1/20000 births [2]. Only few cases of Roux-en-Y gastric bypass (RYGB) in patients with situs inversus totalis were reported [3–6]. We report
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11695-020-04549-6) contains supplementary material, which is available to authorized users. * Tigran Poghosyan [email protected] 1
Department of Digestive, Oncologique and Bariatric Surgery, AP-HP, Hôpital Européen Georges Pompidou and Univsersité de Paris, UFR Paris Descartes, Paris, France
2
Department of Nutrition, AP-HP, Hôpital Européen Georges Pompidou and Univsersité de Paris, UFR Paris Descartes, Paris, France
the laparoscopic RYGB in a patient with a situs inversus totalis.
Case Presentation This is a 58-year-old patient with history of systemic scleroderma, total thyroidectomy, gastroesophageal reflux, known situs inversus totalis, and morbid obesity with body mass index 39 kg/m2. The patient has completed its medical and nutritional monitoring in the department of nutrition of our university teaching hospital. The preoperative assessment confirmed by endoscopy and pHmetry the gastroesophageal reflux disease. After discussion at the multidisciplinary meeting, we decided to perform a RYGB (Video). The patient underwent RYGB procedure in French position. Port site configuration was similar compared with conventional RYGB procedure performed in our department (Fig. 1). Operating time was 130 min, which is much longer compared with
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