title: Minimally invasive duodenojejunostomy for superior mesenteric artery syndrome: a case series and review of the literature.
abstract: BACKGROUND
  Superior mesenteric artery syndrome (SMAS) is a disorder characterized by vascular compression of the duodenum leading to mechanical obstruction. Surgical intervention is indicated in patients who fail standard non-operative management, in which duodenojejunostomy is favored based on previous small series. Given the rarity of the condition, knowledge of the optimal indications for surgery, risk of postoperative complications, and prognosis of SMAS after minimally invasive duodenojejunostomy is limited.
  
  
  METHODS
  A retrospective chart review was performed on patients who underwent minimally invasive duodenojejunostomy for SMAS from March 2005 to December 2013 at our "healthcare system". We analyzed patients' presentations, work-up, surgical therapy, and outcomes.
  
  
  RESULTS
  A series of 14 patients with SMAS underwent minimally invasive duodenojejunostomy. All of these patients met clinical criteria of SMAS with radiological confirmation. Average weight loss before surgery was 10.7 kg. Depression and eating disorders were comorbid in 6/14 patients. The mean age was 39 years (19-91 years). Twelve operations were completed laparoscopically and two were performed with robotic assistance. Mean operation duration was 119 min and average length of hospital stay was 5.5 days. There were no immediate postoperative complications. One patient developed a delayed anastomotic stricture that improved with single endoscopic balloon dilation. Initial symptom improvement occurred in all patients and the improvement occurred in 11 patients (79%) during the follow-up. At a mean follow-up of 20 months, two patients experienced complications, including one infection at a simultaneously placed J-tube site and one patient with dumping syndrome. Mean weight gain was 3.8 kg (p < 0.01).
  
  
  CONCLUSIONS
  SMAS should be considered a potential diagnosis in patients who present with a history of persistent postprandial vomiting, epigastric pain, and weight loss and confirmatory radiographic findings. In well-selected patients, minimally invasive duodenojejunostomy is a safe and effective treatment for SMAS with excellent short-term outcomes.
authors.affiliation: Anesthesiology and Perioperative Medicine, Georgia Regents University, Augusta, GA, 30907, USA, sunzhuo56@hotmail.com.
authors.forename: Zhuo
authors.initials: Z
authors.lastname: Sun
authors.forename: John
authors.initials: J
authors.lastname: Rodriguez
authors.forename: John
authors.initials: J
authors.lastname: McMichael
authors.forename: R Matthew
authors.initials: RM
authors.lastname: Walsh
authors.forename: Sricharan
authors.initials: S
authors.lastname: Chalikonda
authors.forename: Raul J
authors.initials: RJ
authors.lastname: Rosenthal
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Kroh
authors.forename: Kevin
authors.initials: K
authors.lastname: El-Hayek
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods; D019468:Disease Management; D004386:Duodenum / Q000601:surgery*; D006801:Humans; D007583:Jejunum / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D013478:Superior Mesenteric Artery Syndrome / Q000601:surgery*