Laparoscopic sleeve gastrectomy in patients with situs inversus totalis: a systematic review.

BACKGROUND

Laparoscopic sleeve gastrectomy (LSG) is a common metabolic bariatric procedure for obesity. Performing LSG in situs inversus totalis (SIT), a rare congenital anomaly with mirror-image organ reversal, is challenging. This review evaluated the feasibility, safety, and technical considerations of LSG in patients with SIT.

METHODS

A systematic search of PubMed, Scopus, Web of Science, Cochrane Library, and ScienceDirect was conducted for studies published between 2019 and June 2025. The review followed PRISMA 2020 guidance and the Joanna Briggs Institute critical appraisal tools for case reports and case series and was registered with PROSPERO.

RESULTS

Of the 42 records identified, 15 patients from eligible reports were included. The preoperative body mass index (BMI) ranged from 35.8 to 55 kg/m2, and SIT was confirmed by imaging. All surgeries were performed using laparoscopic techniques, with durations ranging from 27 to 130 minutes. Patients were discharged within 2-3 postoperative days. The weight loss ranged from 11.9% to 60%, with a decline in BMI from 22.06 to 40.7 kg/m2. Type 2 diabetes and hypertension showed improvement in the reported cases. Minor complications were observed in two patients. Although reporting quality was acceptable, the certainty of evidence was low because the available data were descriptive and limited to case reports and small series.

CONCLUSION

LSG appears feasible, safe, and effective in patients with SIT when supported by careful preoperative imaging, planning, and minor technical modifications. SIT-related anatomical variation does not appear to adversely affect outcomes.