Jacob A Greenberg, MD EdM, John J Kelly, MD. University of Massachusetts Memorial Medical Center, Worcester, Massachusetts, USA
This submission is a video presentation of a laparoscopic duodenal-jejunal bypass performed for superior mesenteric artery syndrome. Our patient is a 22 year-old female with a longstanding history of epigastric abdominal pain following solid meals. She was able to tolerate liquids and some soft solids without difficulty but solid foods would lead to reproducible obstructive symptoms. These symptoms were somewhat relieved by lying in the left lateral decubitus position. She had no past medical or surgical history and no physical exam abnormalities. Abdominal CT angiogram and an upper GI were consistent with a diagnosis of superior mesenteric artery syndrome. The decision was made to perform a laparoscopic duodenal-jejunal bypass for symptomatic relief. Pneumoperitoneum was obtained via a Veress needle at the umbilicus and four 5mm ports were placed. A thirty-degree, 5mm laparoscope was used for the procedure. A laparoscopic Kocher maneuver was performed until the pancreaticoduodenal complex was completely mobilized from the retroperitoneum. A loop of jejunum was then anastomosed to the lateral second portion of the duodenum using a 45mm stapled anastomosis. The common enterotomy was closed using a single layer of interrupted, full-thickness 2-0 silk sutures and reinforced with an omental flap. The Petersen type defect was closed with a running 0 ethibond suture secured at both ends with Lapra-Tys. Her postoperative course was uncomplicated and she was discharged to home on postoperative day 3 tolerating a soft solid diet. In clinic two weeks later, she had no complaints and was tolerating a regular diet with no recurrence of her previous symptoms.
Program Number: V048