Laparoscopic anti-reflux surgery in a patient with situs inversus totalis

Abstract

Background. Situs inversus totalis (SIT) is a rare congenital anatomical variant, characterized by the opposite arrangement of abdominal and thoracic organs. Open and laparoscopic surgical procedures in patients with SIT can create additional difficulties related to unusual anatomy. Case report. In October 2011 in Department of General Surgery, Chisinau Municipal Hospital Nr.1, was admitted a woman 53 years, who knew about the presence of SIT. She is considered ill for 3 years, complaining heartburn, regurgitation, frequent nocturnal cough. Medical therapy eliminates symptoms incomplete and only for a short time. Endoscopic examination detected reflux esophagitis, grade III by Savary-Miller classification, opened cardia and a 2.5 cm sliding hiatal hernia. According 24-hour pH-metry, De Meester index was 49.93 (normal < 14.72). Laparoscopic Nissen fundoplication and posterior crural closure was performed. Five trocars were placed in mirror-like sites compared to normal anatomical position. The surgery lasted for 150 minutes. Postoperative period was uneventful, patient discharged at the seventh day, after radiological control. Permeability of fundoplication area for contrast material was satisfactory, dysphagia was not observed. On examination after two months, the complete disappearance of symptoms and absence of esophagitis at endoscopy was found. Conclusions. Laparoscopic Nissen fundoplication is a standard method of surgical correction for symptomatic refractory gastro-oesophageal reflux and hiatal hernia. Technical difficulties caused by unusual anatomy in SI are not impassable and do not interfere the successful execution of surgical procedure.