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Publicaciones científicas

Minimally Invasive Surgical Approach for the Treatment of Superior Mesenteric Artery Syndrome: Long-Term Outcomes

06-feb-2020 | Revista: World Journal of Surgery

Cienfuegos JA (1,2,3), Hurtado-Pardo L (4), Valentí V (5,6,7), Landecho MF (6,7,4,8), Vivas I (6,7,4,8,9), Estévez MG (10), Diez-Caballero A (11), Hernández-Lizoáin JL (5,6), Rotellar F (5,6,7).

(1) Department of General Surgery, Clínica Universidad de Navarra, School of Medicine, University of Navarra, Av. Pío XII, 36, 31008, Pamplona, Spain.
(2) Institute of Health Research of Navarra (IdisNA), Pamplona, Spain.
(3) CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, 31008, Pamplona, Spain.
(4) Department of General Surgery, University and Polytechnic La Fe Hospital, Valencia, Spain.
(5) Department of General Surgery, Clínica Universidad de Navarra, School of Medicine, University of Navarra, Av. Pío XII, 36, 31008, Pamplona, Spain.
(6) Institute of Health Research of Navarra (IdisNA), Pamplona, Spain.
(7) CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, 31008, Pamplona, Spain.
(8) Department of Internal Medicine, Clínica Universidad de Navarra, School of Medicine, University of Navarra, Pamplona, Spain.
(9) Department of Radiology, Clínica Universidad de Navarra, School of Medicine, University of Navarra, Pamplona, Spain.
(10) Department of Radiology, Hospital Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain.
(11) Department of General Surgery, Centro Médico Teknon, Barcelona, Spain.


BACKGROUND:
Latero-lateral duodenojejunostomy is the treatment of choice for superior mesenteric artery syndrome (SMAS). The present study analyzes the long-term outcomes in 13 patients undergoing laparoscopic surgery for SMAS.

MATERIALS AND METHODS:
A retrospective study of 10 females and three males undergoing surgery between 2001 and 2013 was performed. Demographic, clinical and radiologic data and long-term surgical outcomes were recorded. In 12 patients latero-lateral duodenojejunostomy and in one patient distal laparoscopic gastrectomy with Roux-en-Y reconstruction were performed.

The median age was 24 years (20-28), and the median duration of symptoms was 24 months (5-24). The most frequent symptoms were abdominal pain (n = 11; 92.3%), nausea and vomiting (n = 10; 77%) and weight loss (n = 9; 69.2%). The median operating time was 98 min (86-138) and hospital stay was 3 days (1-14).

RESULTS:
No reconversions occurred, and one patient experienced gastric emptying delay in the immediate postoperative period with spontaneous resolution. In four patients, SMAS was associated with severe stenosis of the celiac trunk which was treated in the same operation, and four patients presented stenosis of the left renal vein (the "nutcracker" phenomenon).

With a median follow-up of 94 months (SD 65.3), eight patients (61.5%) had excellent results. One patient had a relapse of symptoms 4 years after surgery requiring distal gastrectomy, two patients presented delay in gastric emptying following temporary improvement and one patient experienced no improvement.

CONCLUSIONS:
Latero-lateral duodenojejunostomy yields good results in SMAS although it requires other gastric motility disorders to be ruled out for appropriate treatment to be established.

CITA DEL ARTÍCULO  World J Surg. 2020 Feb 6. doi: 10.1007/s00268-020-05413-5