Laparoscopic and Open Duodenojejunostomy for SMA Syndrome: A Single-Institution Case Series

B Padilla-Jones, N Sutherland, MD, Ed Auyang, MD. University of New Mexico

Introduction: Superior mesenteric artery (SMA) syndrome is a rare condition with less than 500 cases reported in the literature.  Duodenal obstruction occurs when the overlying SMA angulates after rapid weight loss. Surgical treatment is usually reserved for patients who do not respond to nutritional supplementation for attempts at weight gain. In our institution we have begun to explore the use of laparoscopic duodenojejunostomy in select patients.

Methods: A retrospective review was conducted for patients undergoing surgical treatment for SMA syndrome between November 2014- July 2015.  Five patients were identified.  Presentation, patient demographics, intraoperative and post-operative outcomes were extracted.

Results: The most common presenting symptoms were weight loss, nausea, and vomiting. One patient presented with abdominal pain and one patient with bloating. Patient ages ranged from 20-78 years. Weights ranged from 46.1-57.5kg.  All patients underwent advanced imaging to confirm the diagnosis. Two patients underwent laparoscopic duodenojejunostomy (LDJ) and 3 patients underwent open duodenojejunostomy (ODJ). The mean duration for LDJ was 222 minutes vs. 214 minutes for ODJ.  Mean length of hospital stay was 10 days for LDJ and 9 days for ODJ.  One of the LDJ patients required exploratory laparotomy for suspected leak on post-op upper GI series, but exploration revealed no leak and was found to be falsely positive. All patients reported resolution of presenting symptoms at their post-operative clinic visit.

Conclusion: SMA syndrome is a rare clinical entity.  Laparoscopic duodenojejunostomy is a viable option for treatment of SMA syndrome.  In our institutional series, intraoperative and peri-operative outcomes were equivalent between laparoscopic and open approaches.  Additional studies are required to determine selection of LDJ vs. ODJ.

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