Laparoscopic Roux-En-Y Duodenojejunal Bypass for Superior Mesenteric Artery Syndrome

G Higa, A Abdemur, M Gianos, S Szomstein, R J Rosenthal. Cleveland Clinic Florida

Introduction: Superior mesenteric artery syndrome is a clearly defined and uncommon medical condition that can result in severe malnutrition. Surgical intervention is indicated in cases of failed long term medical management.

Case presentations and Methods: We report a series of three cases, a 17-year-old woman, a 23-year-old man and a 50-year-old woman man that were diagnosed with SMAS by upper GI series and/or CAT scan. Medical management failed for one to two-and-half years. They were successfully treated by laparoscopic Roux-en-Y duodenojejunal bypass. A 5-trocar laparoscopic approach was used for the surgery, and a 75 cm long Roux limb was used in all cases. Detailed steps are presented in the attached video with narration. There is no blind loop left with this procedure as compared to gastrojejunostomy and duodenojejunostomy. Branches of the superior mesenteric artery that supply the transverse colon may pass through the peritoneum that covered the third portion of the duodenum. These branches should not be severed so that blood supply to the colon during the preparation of the duodenum proximal to the superior mesenteric artery for anastomosis by dissecting the peritoneum is not compromised.

Results: The postoperative period was unremarkable and symptoms of obstruction subsided in all three cases. All patients were discharged home tolerating a soft diet.
Conclusions: Laparoscopic duodenojejunal bypass appears to be a feasible and safe treatment option for superior mesenteric artery syndrome.