Authors: Julietta Chang Mena Boules John Rodriguez Matthew Walsh Raul Rosenthal Matthew Kroh
Publish Date: 2016/07/12
Volume: 31, Issue: 3, Pages: 1180-1185
Abstract
Superior mesenteric artery syndrome SMAS is a rare condition caused by partial obstruction of the third portion of the duodenum by the SMA anteriorly and aorta posteriorly Laparoscopic duodenojejunostomy has been described as a safe and feasible surgical intervention with favorable shortterm outcomes However descriptions of intermediate outcomes are lacking in the literatureEighteen patients with mean age of 312 were identified There were 4 men and 14 women Patients’ diagnosis was made by clinical presentation with radiographic confirmation Mean weight loss preoperatively was 139 kg representing 241 total body weight loss There were no intraoperative complications Postoperatively 2 patients developed prolonged ileus One underwent exploratory laparotomy and washout for presumed leak but none was identified Three patients were readmitted within 30 days 2 for intolerance to enteral intake with dehydration and 1 for closedloop obstruction requiring laparoscopic lysis of adhesions The average and median length of followup were 277 and 260 months respectively Patients gained an average of 22 kg with an increase in body mass index of from 196 to 204 m/kg2 Although 14 of 18 patients reported initial symptom improvement at latest followup only 6 patients reported symptomatic improvement or resolution Three were diagnosed with global dysmotility and 1 underwent intestinal transplant Two were diagnosed with gastroparesis and 1 underwent a laparoscopic gastric electric stimulator placement and pyloroplasty There were no mortalitiesDuodenojejunostomy is the most common surgical intervention in management of SMAS Our intermediate followup reveals infrequent improvement and rare resolution of preoperative symptomatology Patients had a modest average weight gain postoperatively This may suggest that different preoperative workup and treatment is indicated
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