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SMA syndrome: management perspective with laparoscopic duodenojejunostomy and long-term results

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Abstract

Background

Superior mesentery artery syndrome (SMAS) is a rare vasculo-anatomic occlusive pathologic entity for which a period of conservative medical management is advocated with surgery reserved for nonresponsive cases. We present our management plan that entails a single admission approach and complete rendering of medical and surgical treatment to the patient on a background of the socioeconomic and cultural trends prevalent in this geographic region.

Methods

A retrospective analysis of 22 cases of SMAS admitted in our health care system who underwent a period of preoperative conditioning followed by laparoscopic duodenojejunostomy from September 2009 to June 2019 was performed. Patients were followed up at regular intervals.

Results

The mean follow-up of the cohort was 41.2 months (2–108 months). The median length of stay was 6 days. The mean postoperative stay was 4.13 days. A subgroup of six patients who had severe physiological depletion required a period of preoperative optimisation. Five of the 22 (22.7%) patients suffered from postoperative complications in the form of delayed return of bowel functions. None of the patients had complications more than Clavien–Dindo grade 2 with no mortality. Long-term data are available for 19 patients (86.3%) which showed no symptom recurrence.

Conclusion

Management of SMAS that entails an antecedent medical therapy followed by surgery can be accomplished in a single admission with good to excellent results in the intermediate and long-term follow-up. Physiologically depleted patients do require a period of intensive preconditioning but on long-term follow-up, they have excellent results.

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Authors and Affiliations

  1. Department of Surgical Gastroenterology and Minimal Invasive Surgery, Santokba Institute of Digestive Surgical Sciences, Santokba Durlabhji Memorial Hospital and Medical Research Center, Jaipur, Rajasthan, India

    Nikhil Jain, Amit Chopde, Banshidhar Soni, Bhuwanesh Sharma, Suresh Saini, Siddharth Mishra, Subhash Mishra, Rajkumar Gupta & Rajesh Bhojwani

  2. Santokba Durlabhji Memorial Hospital and Medical Research Institute, SIDSS Office, 3rd floor, IPD Block, Bhawani Singh Road, Jaipur, Rajasthan, 302015, India

    Rajesh Bhojwani

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  1. Nikhil Jain
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  2. Amit Chopde
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Correspondence to Rajesh Bhojwani.

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Nikhil Jain, Amit Chopde, Banshidhar Soni, Bhuwanesh Sharma, Suresh Saini, Sidharth Mishra, Subhash Mishra, Rajkumar Gupta and Rajesh Bhojwani have no conflicts of interest or financial ties to disclose.

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Jain, N., Chopde, A., Soni, B. et al. SMA syndrome: management perspective with laparoscopic duodenojejunostomy and long-term results. Surg Endosc 35, 2029–2038 (2021). https://doi.org/10.1007/s00464-020-07598-1

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