Department of General Surgery and Semiology no. 3 Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova, The 8th International Medical Congress for Students and Young Doctors, September 24-26, 2020Background. Situs inversus totalis (SIT) is a rare congenital anatomical variant, characterized
by the opposite arrangement of abdominal and thoracic organs. Open and laparoscopic surgical
procedures in patients with SIT can create additional difficulties related to unusual anatomy.
Case report. In October 2011 in Department of General Surgery, Chisinau Municipal Hospital
Nr.1, was admitted a woman 53 years, who knew about the presence of SIT. She is considered
ill for 3 years, complaining heartburn, regurgitation, frequent nocturnal cough. Medical therapy
eliminates symptoms incomplete and only for a short time. Endoscopic examination detected
reflux esophagitis, grade III by Savary-Miller classification, opened cardia and a 2.5 cm sliding
hiatal hernia. According 24-hour pH-metry, De Meester index was 49.93 (normal < 14.72).
Laparoscopic Nissen fundoplication and posterior crural closure was performed. Five trocars
were placed in mirror-like sites compared to normal anatomical position. The surgery lasted
for 150 minutes. Postoperative period was uneventful, patient discharged at the seventh day,
after radiological control. Permeability of fundoplication area for contrast material was
satisfactory, dysphagia was not observed. On examination after two months, the complete
disappearance of symptoms and absence of esophagitis at endoscopy was found.
Conclusions. Laparoscopic Nissen fundoplication is a standard method of surgical correction
for symptomatic refractory gastro-oesophageal reflux and hiatal hernia. Technical difficulties
caused by unusual anatomy in SI are not impassable and do not interfere the successful
execution of surgical procedure
