Laparoscopic Duodenojejunostomy for Superior Mesenteric Artery Syndrome

Abstract

Superior mesenteric artery (SMA) syndrome is an uncommon condition of duodenal obstruction secondary to extrinsic vascular compression. With the advent of laparoscopy, an emerging option to treat SMA syndrome is laparoscopic duodenojejunostomy. Given the rarity of the condition a critical appraisal of the effectiveness and safety of this relatively new surgical option has not been performed. Here we present a case report and a critical review of all published reports of laparoscopic duodenojejunostomy. A systematic literature review of all published reports describing laparoscopic duodenojejunostomy was performed by querying the MEDLINE database using keywords: laparoscopic duodenojejunostomy and SMA syndrome. Nine articles were reviewed which were mainly case reports and case series (level 5 data), reporting on a total of 13 patients, with 32 per cent of the patients being male and 68 per cent female. The diagnosis was established preoperatively in 62 per cent of the cases, the length of stay was 4.5 days, the morbidity rate was 7 per cent, and no mortalities were reported. The operation was considered successful in 100 per cent of patients. Laparoscopic duodenojejunostomy seems to be a safe and effective treatment for patients with SMA syndrome, but more data is required to recommend this operative option as the standard of care.