Laparoscopic Nissen fundoplication for gastroesophageal reflux disease in situs inversus totalis: a “self-solving puzzle”—a case report

Abstract

: We report a laparoscopic Nissen fundoplication for gastroesophageal reflux disease (GERD) in a patient with situs inversus totalis (SIT), focusing on the surgical anatomical challenge. GERD with SIT is a very rare condition, and because of its extremely low prevalence, it presents a once-in-a-lifetime challenge for the gastroesophageal surgeon. A laparoscopic approach with minimum modifications enabled us to perform surgery as in patients with normal anatomy. In this article we describe in detail how we adapted the surgical technique to the anatomic alteration, so it can be reproduced elsewhere. We share our experience and the challenges we encountered, with the objective to give insight to a surgeon confronting a similar scenario. This is the case of a 65-year-old female, with hiatal hernia, GERD symptoms, and chronic obstructive pulmonary disease (COPD) exacerbations, which required continuous treatment adjustment. After proper evaluation, we performed a hiatoplasty and laparoscopic floppy Nissen, with only surgical ports placement modifications. We found few difficulties during surgery and a swift and ergonomic dissection for the right-handed surgeon. The patient was discharged on the second day after tolerating oral feeds. After 6 months, the patient remains asymptomatic without further COPD exacerbations. To the best of our knowledge, we present which is possibly the first reported case of a laparoscopic Nissen fundoplication in SIT in Latin America.