A.C. Greene1, J. Hughes1, M. Zukowski1, A. Pino1, A. Sinha1, P. Curran1, A.N. Kulaylat1, A.Y. Tsai1 1Penn State Children’s Hospital, Surgery, Hershey, PA, USA
Introduction: Superior Mesenteric Artery Syndrome (SMAS) is a rare gastrointestinal condition caused by vascular compression of the third part of the duodenum between the superior mesenteric artery (SMA) and the aorta. Initial management is conservative; however, surgical management may become necessary if lifestyle modification around eating habits and nutritional optimization to encourage weight gain fail to resolve the symptoms. Controversy remains in the optimal operative approach to address this condition. In this study, we present a case series of pediatric patients who underwent laparoscopic complete small intestinal derotation for SMAS, evaluating patient outcomes and resolution of symptoms after the procedure.
Methods: This was a single-institution retrospective chart review of pediatric SMAS patients who underwent laparoscopic complete intestinal derotation with appendectomy by a single pediatric surgeon at a tertiary children’s hospital. Patients' demographics and surgical outcomes were collected. Resolution of symptoms, feeding tolerance, and weight gain were obtained from patient follow-up visits. Descriptive statistics were performed.
Results: Twelve pediatric patients, all females, with a mean age of 17.2 (±1.6) years and mean BMI of 17.1 (±2.1) were included. All patients had clinical and radiographic evidence of SMAS. Presenting symptoms included weight loss (100%), abdominal pain (91.7%), nausea (41.7%), and vomiting (67%). 58.3% of patients required supplemental nutrition prior to surgery, including total parenteral nutrition (N=3) and/or tube feeds via nasojejunal tube (N=3), gastrojejunal tube (N=2), jejunostomy tube (N=1). Postoperatively, 91.7% of patients had eventual resolution of symptoms associated with SMAS with 66.7% of patients achieving resolution within six months of the operation without needing supplemental nutrition. One patient (8.3%) required duodenojejunostomy to achieve symptom resolution. No reoperations within 30 days were required.
Conclusion: When surgical intervention is necessary, laparoscopic complete small intestinal derotation is a promising treatment option for refractory SMAS and a viable alternative to avoid an open procedure or construction of an anastomosis.