Our Summary

Situs inversus totalis (SIT) is a rare condition where a person’s organs in the chest and abdomen are flipped, like a mirror image, from their normal positions. This can make surgeries more complicated. There are not many reports of performing laparoscopic surgery (surgery done through small incisions using a camera) for colorectal cancer in patients with this condition.

The research paper discusses a successful laparoscopic surgery performed on a patient with SIT who had sigmoid colon cancer. The surgery involved moving the colon, tying off certain blood vessels, and completely removing a part of the colon. The surgeon stood on the patient’s left side, which is the opposite of where they would normally stand for this type of surgery.

The surgeon used a 12-mm trocar (a device used to create a small hole for surgery) in the left iliac fossa (the area on the left side of the lower abdomen) and an automatic endoscopic linear stapler (a device that cuts and staples tissue). This allowed the surgeon to perform the surgery without having to change their position or move the camera in the middle of the procedure. The paper concludes that the automatic endoscopic linear stapler is useful for this type of surgery in patients with SIT.

FAQs

  1. What is Situs inversus totalis (SIT) and how does it affect surgical procedures?
  2. How was the laparoscopic surgery performed in a patient with SIT and sigmoid colon cancer?
  3. What role does an automatic endoscopic linear stapler play in a laparoscopic sigmoidectomy for a patient with SIT?

Doctor’s Tip

One helpful tip a doctor might give a patient about sigmoidectomy is to make sure to follow post-operative care instructions carefully, including taking prescribed medications, eating a healthy diet, and avoiding strenuous activities until fully healed. It is also important to attend follow-up appointments with your doctor to monitor your recovery progress and address any concerns or complications that may arise.

Suitable For

Patients with sigmoid colon cancer who also have situs inversus totalis may be recommended for sigmoidectomy. Laparoscopic surgery may be a viable option for these patients, with the use of techniques such as colonic mobilization, high ligation of the inferior mesenteric vessels, and complete mesocolic excision. Surgeons may need to adjust their positioning and use specialized equipment, such as an automatic endoscopic linear stapler, to successfully perform the procedure in patients with situs inversus totalis.

Timeline

  • Before sigmoidectomy:
  1. Patient presents with symptoms such as abdominal pain, changes in bowel habits, and blood in stool.
  2. Patient undergoes diagnostic tests such as colonoscopy and imaging studies to confirm the presence of sigmoid colon cancer.
  3. Patient consults with a surgeon to discuss treatment options, including laparoscopic sigmoidectomy.
  4. Preoperative preparation, including bowel cleansing and dietary restrictions, is conducted before the surgery.
  • After sigmoidectomy:
  1. Laparoscopic sigmoidectomy is performed, involving colonic mobilization, high ligation of the inferior mesenteric vessels, and complete mesocolic excision.
  2. The operating surgeon stands on the patient’s left side, opposite the normal location for sigmoidectomy due to the patient’s situs inversus totalis.
  3. A 12-mm trocar is placed in the left iliac fossa, and an automatic endoscopic linear stapler is used for left-handed colon resection.
  4. The procedure is completed without the need to change position or move the laparoscopic monitor mid-procedure.
  5. Postoperative care includes pain management, monitoring for complications such as infection or bowel obstruction, and gradual resumption of normal activities.
  6. Patient undergoes follow-up appointments and surveillance to monitor for recurrence of cancer and assess overall recovery.

What to Ask Your Doctor

  1. What is sigmoidectomy and why is it recommended for my condition?
  2. What are the potential risks and complications associated with sigmoidectomy?
  3. How will my situs inversus totalis affect the surgical procedure?
  4. What is the expected recovery time and post-operative care after sigmoidectomy?
  5. Are there any alternative treatment options to consider?
  6. How experienced are you in performing laparoscopic surgery in patients with situs inversus totalis?
  7. Will I need any special accommodations or considerations during the surgical procedure due to my anatomy?
  8. How will my long-term outcome and prognosis be affected by having sigmoidectomy with situs inversus totalis?
  9. Are there any lifestyle changes or dietary restrictions I should be aware of after the surgery?
  10. What follow-up appointments and monitoring will be necessary after the procedure?

Reference

Authors: Takeda T, Haraguchi N, Yamaguchi A, Uemura M, Miyake M, Miyazaki M, Ikeda M, Sekimoto M. Journal: Asian J Endosc Surg. 2019 Jan;12(1):111-113. doi: 10.1111/ases.12483. Epub 2018 Mar 30. PMID: 29601667