title: Laparoscopic management of duodenal obstruction resulting from superior mesenteric artery syndrome.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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
  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.
authors.affiliation: Department of Graduate Medical Education, Exempla Saint Joseph Hospital, Denver, Colorado.
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Pottorf
authors.affiliation: Division of Metabolic-Surgical Weight Management, Colorado Permanente Medical Group, Denver.
authors.forename: Farah A
authors.initials: FA
authors.lastname: Husain
authors.affiliation: Department of Graduate Medical Education, Exempla Saint Joseph Hospital, Denver, Colorado.
authors.forename: H Whitton
authors.initials: HW
authors.lastname: Hollis
authors.affiliation: Department of Surgery, Emory University, Atlanta, Georgia.
authors.forename: Edward
authors.initials: E
authors.lastname: Lin
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods; D004380:Duodenal Obstruction / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D004386:Duodenum / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013478:Superior Mesenteric Artery Syndrome / Q000150:complications* / Q000175:diagnosis; D016896:Treatment Outcome; D055815:Young Adult