Outcomes After Duodenoduodenostomy for Superior Mesenteric Artery Syndrome.

Abstract

Superior Mesenteric Artery Syndrome (SMAS) is a very rare disease that causes starvation and malnutrition secondary to a mechanical obstruction of the 3rd portion of the duodenum between the superior mesenteric artery and aorta. Long-term outcomes following surgery for SMAS by current methods have a high failure rate of 21%-67%. We report the 3-year outcomes of a novel operation for SMAS described as the duodenoduodenostomy (DD). This is a longitudinal case series of 12 patients who underwent the DD operation for SMAS, comparing pre-surgery to post-surgery 3-year outcomes. Weight, Body Metabolic Index (BMI), iron levels, and subjective data were collected to assess restoration of nutrition, correction of malabsorption, and lifestyle. The Wilcoxon signed-rank test was applied to nonparametric matched or dependent samples, with statistical significance set at P < 0.05. At the end of 3 years, there was a significant increase in median weight and BMI, at 108 lbs vs 123.1 lbs (P-value 0.0156) and a BMI of 18.57 vs 20.59 (P-value 0.0161). At 3 months, iron levels normalized after surgery and stayed normal at 45 mcg/dL vs 130 mcg/dL (P-value = 0.046). After 3 years, 75% of patients gained weight and BMI while 83% were able to maintain their BMI to a normal range. Our study demonstrates that DD surgery leads to significant increases in weight and BMI, accompanied by improved iron levels. The DD procedure emerges as a promising surgical option in the definitive treatment for SMAS.