Wills Mélissa V, Barajas-Gamboa Juan S, Mocanu Valentin, Conner Andrew, Brown John, Restrepo-Rodas Gabriela, Lee Sol, Navarrete Salvador, Corcelles Ricard, Allemang Matthew, Rodriguez John, Strong Andrew, Dang Jerry, Kroh Matthew
Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA.
Digestive Disease Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates.
Surg Endosc. 2025 Aug;39(8):5235-5243. doi: 10.1007/s00464-025-11774-6. Epub 2025 Jun 27.
Superior mesenteric artery syndrome (SMAS) is caused by partial obstruction of the duodenum between the SMA and the aorta. While laparoscopic duodenojejunostomy (DJ) shows favorable short- and intermediate-term outcomes, characterization of long-term outcomes remains limited.
An IRB-approved retrospective study was conducted on patients who underwent laparoscopic DJ from January 2007 to January 2023 at our center. SMAS diagnosis was confirmed through clinical presentation and radiographic studies. Data on BMI, symptoms, and nutritional support were collected preoperatively and at last follow-up. A McNemar test was performed to compare preoperative and long-term outcomes.
Twenty-five patients (median age 32.1 years, IQR 23.2-45.3) with a median follow-up of 5.3 years (IQR 3.0-8.5) were identified. BMI increased from median of 19.2 kg/m (IQR 17.8-21.1) to 21.6 kg/m (IQR 18.0-23.8) at the time of last follow-up (p = 0.005). The number of patients dependent on enteral tube feeds and total parenteral nutrition decreased within this time frame (36.0% to 28.0%, p = 0.4795). Fewer patients underwent procedures for enteral access placement preoperatively than by the time of last follow-up (36.0% to 12.0%, p = 0.1573). Abdominal pain (p < 0.001), nausea (p < 0.001), vomiting (p = 0.3657), bloating (p = 0.2568), and weight loss (p < 0.001) decreased within this time frame. No significant changes were observed in antiemetic (p = 0.7389) or prokinetic (p = 0.5637) use. Seven patients (28.0%) required major surgical interventions for diagnoses of gastrointestinal motility disorders. Four of these patients (16.0%) died during the final follow-up period.
Laparoscopic DJ shows long-term benefits for SMAS, including improved BMI, reduced supplemental feeding dependence, and significant symptom relief, particularly for pain, nausea, and vomiting. However, a significant proportion of patients with concurrent gastrointestinal motility disorders had worse outcomes, required additional surgical interventions, and experienced higher mortality rates, underscoring the importance of both thorough preoperative evaluation and vigilant longitudinal follow-up for this complex patient population.
肠系膜上动脉综合征（SMAS）是由肠系膜上动脉（SMA）与主动脉之间的十二指肠部分梗阻引起的。虽然腹腔镜十二指肠空肠吻合术（DJ）显示出良好的短期和中期效果，但长期效果的特征仍有限。
对2007年1月至2023年1月在本中心接受腹腔镜DJ手术的患者进行了一项经机构审查委员会批准的回顾性研究。通过临床表现和影像学检查确诊SMAS。收集术前和最后一次随访时的体重指数（BMI）、症状和营养支持数据。进行McNemar检验以比较术前和长期结果。
确定了25例患者（中位年龄32.1岁，四分位间距23.2 - 45.3），中位随访时间为5.3年（四分位间距3.0 - 8.5）。最后一次随访时，BMI从中位数19.2kg/m（四分位间距17.8 - 21.1）增加到21.6kg/m（四分位间距18.0 - 23.8）（p = 0.005）。在此时间段内，依赖肠内管饲和全胃肠外营养的患者数量减少（36.0%至28.0%，p = 0.4795）。术前接受肠内通路放置手术的患者比最后一次随访时少（36.0%至12.0%，p = 0.1573）。在此时间段内，腹痛（p < 0.001）、恶心（p < 0.001）、呕吐（p = 0.3657）、腹胀（p = 0.2568）和体重减轻（p < 0.001）均有所减轻。止吐药（p = 0.738）或促动力药（p = 0.5637）的使用无显著变化。7例患者（28.0%）因诊断为胃肠动力障碍而需要进行重大手术干预。其中4例患者（16.0%）在最后随访期间死亡。
腹腔镜DJ对SMAS显示出长期益处，包括BMI改善、补充喂养依赖性降低以及症状显著缓解，尤其是疼痛、恶心和呕吐。然而，相当一部分并发胃肠动力障碍的患者预后较差，需要额外的手术干预，且死亡率较高，这凸显了对这一复杂患者群体进行全面术前评估和密切纵向随访的重要性。
