Laparoscopic Duodenojejunostomy for the Treatment of Superior Mesenteric Artery Syndrome: Analysis of 91 Patients

Abstract

Superior mesenteric artery syndrome (SMAS) is a rare condition caused by the compression of the third portion of the duodenum between the aorta and the superior mesenteric artery (SMA). Laparoscopic duodenojejunostomy has emerged as a safe and effective surgical treatment, particularly when conservative measures fail. We analyzed the clinical and surgical outcomes of 91 patients who underwent laparoscopic duodenojejunostomy for SMAS between February 2016 and July 2023. Preoperative clinical characteristics, surgical data, postoperative symptom improvement rates, and weight regain were evaluated. Diagnosis was confirmed through computed tomographic angiography (CTA), demonstrating an aortomesenteric angle < 20° and distance < 10 mm. Conservative treatment was initially applied in all cases prior to surgical intervention. Among the 91 patients, 58.2% were female, and the mean age was 29.2 SD 11 years. All surgeries were completed laparoscopically with no intraoperative complications. After an average follow-up of 42.5 SD 26.7 months, 93.4% of patients showed significant symptom improvement, with a mean postoperative weight gain of 4.5 SD 2.5 kg. Postoperative complications included delayed gastric emptying in 8 patients (resolved conservatively) and low-output chylous fistulas in 4 patients (resolved spontaneously). There was no mortality. Laparoscopic duodenojejunostomy is a safe and effective treatment for SMAS, offering high success rates and minimal complications. While this study highlights the benefits of a multidisciplinary approach and standardized surgical techniques, further prospective studies are needed to optimize management protocols for this rare condition.