V-06. Surgical Treatment of Gastroesophageal Reflux Disease in a Patient With Situs Inversus Totalis and Kartagener Syndrome

Abstract

Benign Disease: Gastro-Esophageal Reflux and Hiatal Hernia Situs inversus totalis is a rare genetic condition characterized by a complete mirror-image transposition of thoracic and abdominal organs. This anatomical anomaly poses technical challenges for surgeons, often requiring adaptations in surgical techniques. Kartagener syndrome, a subset of primary ciliary dyskinesia, includes situs inversus totalis, chronic sinusitis, and bronchiectasis. Patients with this syndrome may develop gastroesophageal reflux disease (GERD), which can adversely affect pulmonary function, especially post-lung transplantation. Fundoplication with hiatoplasty in patients with situs inversus totalis and Kartagener syndrome is feasible and safe, provided there is thorough preoperative planning and adaptation of the technique to the inverted anatomy. Prior knowledge of the condition and meticulous planning are essential for the success of the procedure. We present the case of a 39-year-old male patient with situs inversus totalis and Kartagener syndrome who experienced progressive deterioration of graft function following bilateral lung transplantation, attributed to GERD. Spirometry confirmed the decline in pulmonary function. Consequently, a Nissen fundoplication with hiatoplasty was indicated to manage GERD. During the surgical procedure, the inverted anatomical positioning necessitated modifications in team positioning and trocar placement, as well as technical adaptations. The surgery proceeded without complications, and a standard Nissen fundoplication was successfully performed. Literature reports on abdominal surgeries in patients with situs inversus totalis are scarce, underscoring the rarity and the need for individualized approaches. The altered anatomy can complicate the dissection of structures and increase the risk of complications.