Introduction and Importance: Obesity is a worldwide pandemic and is closely associated with an increased risk of comorbidities and overall mortality. Surgery has emerged as an essential strategy to ameliorate obesity-attributable comorbidities and as a powerful weight-loss tool. Due to the increasing number of obese patients predicted to elect surgery, individuals with rare anomalies such as situs inversus can be expected. Case presentation: We present the case of a 49-year-old woman with situs inversus with levocardia. She had a high BMI and was admitted for bariatric surgery. After several adjustments to our technique, the procedure was completed without complications. Clinical discussion: Laparoscopic bariatric surgeries are highly demanding; variations from the normal anatomy could challenge the medical team. Conclusion: Preoperative diagnosis and highly trained surgeons is of paramount importance to adequately treat every patient.