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Difficult Decisions in Vascular Surgery pp 275–286Cite as

In Patients with Superior Mesenteric Artery Syndrome, Is Enteric Bypass Superior to Duodenal Mobilization?

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Part of the book series: Difficult Decisions in Surgery: An Evidence-Based Approach ((DDSURGERY))

Abstract

Superior mesenteric artery syndrome is an infrequent cause of duodenal obstruction within the narrowed aortomesenteric angle. The condition is characterized by vague and elusive symptomatology thus often making it difficult to diagnose. In addition, the etiology remains poorly defined and standard diagnostic criteria are lacking. Following a trial of supportive medical management, the surgical treatment options include traditional open or minimally invasive duodenojejunostomy, division of the ligament of Treitz (Strong’s procedure), or gastrojejunostomy. Duodenojejunostomy has been the favored surgical technique historically and most described in the literature. Due to the rarity of the syndrome and overall inconsistencies in diagnosis and treatment, there is a paucity of evidence in the literature to strongly recommend one technique over the other. Available case series and case reports lack appropriate follow-up. Based on the existing data and our personal experience, our preference is to perform a laparoscopic duodenojejunostomy for the treatment of medically refractory SMA syndrome. However, larger and more rigorous studies will be needed to make more evidence-based recommendations.

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Author information

Authors and Affiliations

  1. Department of Surgery, University of Chicago Medical Center, Chicago, IL, USA

    Monika A. Krezalek

  2. Department of Surgery, Pritzker School of Medicine, University of Chicago, Chicago, IL, USA

    John C. Alverdy MD

Authors
  1. Monika A. Krezalek
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  2. John C. Alverdy MD
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Correspondence to John C. Alverdy MD .

Editor information

Editors and Affiliations

  1. The University of Chicago Medical Center and Biological Science Division, Chicago, Illinois, USA

    Christopher L. Skelly

  2. The University of Chicago Medical Center and Biological Science Division, Chicago, Illinois, USA

    Ross Milner

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Krezalek, M.A., Alverdy, J.C. (2017). In Patients with Superior Mesenteric Artery Syndrome, Is Enteric Bypass Superior to Duodenal Mobilization?. In: Skelly, C., Milner, R. (eds) Difficult Decisions in Vascular Surgery. Difficult Decisions in Surgery: An Evidence-Based Approach. Springer, Cham. https://doi.org/10.1007/978-3-319-33293-2_23

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  • DOI: https://doi.org/10.1007/978-3-319-33293-2_23

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-33291-8

  • Online ISBN: 978-3-319-33293-2

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