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Brief Report
Resident's Forum
December 2014

Laparoscopic Management of Duodenal Obstruction Resulting From Superior Mesenteric Artery Syndrome

Author Affiliations
  • 1Department of Graduate Medical Education, Exempla Saint Joseph Hospital, Denver, Colorado
  • 2Division of Metabolic–Surgical Weight Management, Colorado Permanente Medical Group, Denver
  • 3Department of Surgery, Emory University, Atlanta, Georgia
JAMA Surg. 2014;149(12):1319-1322. doi:10.1001/jamasurg.2014.1409

Importance  Duodenal obstruction by compression from the superior mesenteric artery (SMA) can be managed using minimally invasive techniques initially developed for bariatric patients requiring gastric bypass.

Observations  This retrospective review evaluates 12 patients with SMA syndrome who were treated with laparoscopic enteric bypass. Technical considerations are presented in detail. The study group comprised 5 men and 7 women, with ages ranging from 21 to 65 years (mean, 36.8 years). Operative times ranged from 53 to 126 minutes (mean, 72.4 minutes). Mean length of hospital stay was 4.2 days (range, 3-7 days). Obstructive symptoms were improved or eliminated in 11 patients (92%). One patient required readmission for inadequate control of generalized abdominal pain. No patients in this series developed postoperative bowel obstruction, wound complications, or anastomotic leaks or died.

Conclusions and Relevance  Laparoscopic duodenojejunostomy is safe and effective and should be considered the optimal treatment for patients presenting with duodenal obstruction from SMA syndrome. Advances in minimally invasive surgery have demonstrated the safety and low morbidity of laparoscopically created enteric anastomoses. The shorter hospital stay, low morbidity, and high success of laparoscopic enteric bypass make this approach favorable to traditional open techniques.