Intestinal congenital rotational anomalies, malrotation/nonrotation and situs inversus are very rare in adults (0.00001 to 0.19%). They are usually asymptomatic and found incidentally at surgery or after diagnostic imaging. During bariatric surgery, such anatomical anomalies can pose an additional technical challenge. Familiarity with such anomalies, early detection and understanding the anatomy allow for safe laparoscopic intervention.
We retrospectively reviewed, prospectively maintained, Geisinger Bariatric Surgery Registry of all bariatric surgeries in last 20 years. The occurrence of intestinal rotational anomalies noted at initial surgery and perioperative and long-term outcomes were analyzed.
Ten cases (out of 7814; 0.13%) of rotational anomalies were found. Two situs inversus and eight with intestinal malrotations. There were 4 males and 6 females, average age 43.7 years and BMI of 46.6 kg/m2. Eight procedures were completed by laparoscopic approach including one robotic assisted, one was laparoscopic converted to open and one was done by open bariatric surgeon. There were nine RYGB's and one sleeve gastrectomy. No perioperative or immediate 30-day complications were reported. Average LOS was 1.8 days.
Bariatric surgery to include anastomotic cases can be safely performed in patients with rotational anomalies. Peri-operative and long-term outcomes are similar to patients without rotational anomalies. Early operative recognition by routine initial visualization of ligament of Treitz allows early recognition of the anatomic anomalies and technical considerations.