Situs inversus totalis is a congenital condition characterized by a mirror-image arrangement of the thoracic and abdominal organs. Although it generally does not affect life expectancy, it may pose technical challenges in surgical procedures. This study aims to report the case of a patient with class III obesity and a diagnosis of situs inversus totalis who underwent laparoscopic sleeve gastrectomy. The patient was a 33-year-old female with a body mass index of 48 kg/m², associated comorbidities, and an indication for bariatric surgery. The diagnosis was established during preoperative evaluation through imaging studies. The procedure was performed with adaptations to the laparoscopic technique, including mirrored trocar placement. The patient had a satisfactory postoperative course, without complications, early discharge, and appropriate clinical progression during outpatient follow-up, demonstrating the safety and feasibility of this approach.