# Laparoscopic Anterior 180° Partial Fundoplication in Situs Inversus Totalis: Technical Considerations and Literature Review

## TL;DR

This paper describes a successful laparoscopic surgery for GERD in a patient with reversed organ anatomy, using a modified technique not previously reported.

## Contribution

The first reported case of laparoscopic anterior 180° partial fundoplication in a patient with situs inversus totalis.

## Key findings

- Laparoscopic anterior 180° partial fundoplication was successfully performed in a patient with situs inversus totalis.
- Technical adaptations such as mirror-image port placement and modified suturing were essential for the procedure.
- The patient had complete symptom resolution and good outcomes at one-year follow-up.

## Abstract

Situs inversus totalis (SIT) is a rare congenital condition characterized by complete mirror-image transposition of thoracic and abdominal organs. Gastroesophageal reflux disease (GERD) secondary to hiatal hernia in such patients presents unique diagnostic and technical challenges for laparoscopic surgery. Literature review revealed only six previous cases of laparoscopic fundoplication in SIT, all employing Nissen fundoplication techniques. We report a 28-year-old female with SIT and symptomatic GERD who underwent successful laparoscopic hiatal hernia repair with anterior 180° partial fundoplication. The procedure required specific technical adaptations, including mirror-image port placement and modified suturing ergonomics to accommodate the reversed anatomy. Surgery was completed in 98 minutes without complications. At one-year follow-up, the patient achieved complete symptom resolution with excellent functional outcomes. This represents the first reported case of laparoscopic anterior partial fundoplication in SIT, demonstrating the feasibility and safety of this approach in patients with reversed anatomy when appropriate technical modifications are employed.