Robotic Conversion of Sleeve Gastrectomy to Gastric Bypass in a Patient With Situs Inversus Totalis: A Case Report

Bariatric surgeries are increasingly commonplace in treating morbid obesity and the associated comorbidities. Situs inversus totalis (SIT) represents a rare anatomical deviation in which the thoracic and abdominal viscera are in mirror-image positions compared with normal anatomy. The paucity of literature on surgical outcomes of this condition underscores the need for this report. Understanding the preoperative workup and unique operative technical challenges will help surgeons better prepare for such rare cases. We present a case of a 54-year-old female with known SIT, morbid obesity, obstructive sleep apnea, and cardiac arrhythmias with an automatic implantable cardioverter defibrillator (AICD) in place. The patient presented with complaints of regurgitation and weight regain seven years after laparoscopic sleeve gastrectomy at another facility. After appropriate preoperative workup, the patient was offered conversion to gastric bypass. We proceeded with a robotic conversion of sleeve gastrectomy to gastric bypass with no intraoperative or postoperative events. At the one-month follow-up visit, the patient tolerated her diet and was compliant with medications and vitamins. This report represents the first documented case of robotic sleeve conversion to gastric bypass in a patient with SIT. Robotic surgery is useful in improving surgical precision and ergonomics in complex cases and highlights its feasibility in such rare cases. We conclude that robotic bariatric surgery is safe in patients with SIT, provided that all preoperative workup is completed and necessary anatomical precautions are taken during the procedure.