Surgical Management for Superior Mesentery Artery Syndrome in Korea: Including Korean literature Review

Sung, Seong Hoon; Won, Dal Yeon; Kim, Ik Yong; Cho, Nam Cheon; Kim, Dae Sung; Rhoe, Byoung Seon

Abstract

PURPOSE
Superior mesenteric artery (SMA) syndrome is a rare disorder, characterized by a decreased aortomesenteric angle that causes a duodenal obstruction. It usually occurs after a period of weight loss, nausea or vomiting due to a partial obstruction of the third portion of the duodenum. If conservative management fails, then a laparotomy, with a duodenojejunostomy, is indicated. A minimally invasive laparoscopic approach to the retroperitoneum, or duodenal, operation has recently been introduced. Although the role of laparoscopy in the management of SMA syndrome is not clearly defined, a laparoscopic duodenojejunostomy may be an alternative approach for its surgical treatment. METHODS: We retrospectively reviewed and analysed our experience of 8 cases of SMA syndrome, and included another 45 cases that had previously been reported in the Korean literature since 1967. RESULTS: There was no gender predominance, but SMA syndrome was more common in younger patients. There were several diseases, or underlying conditions, associated with gastrointestinal, or other general conditions, in SMA syndrome. With respect to its surgical management, most cases in Korea were treated with a duodenojejunostomy. We recently experienced two cases of superior mesenteric artery syndrome, which were treated laparoscopically. The operation time and lenghth of hospital stay were acceptable, with no complications. CONCLUSION: SMA syndrome shows a greater predominance in young age, and is associated with many other diseases, or conditions, in Korea. A duodenojejunostomy is the best choice of operative procedure for the treatment of SMA syndrome. A laparoscopic duodenojejunostomy is also a feasible, alternative option in the treatment of SMA syndrome, providing the benefits of a definitive and minimally invasive surgical technique for a duodenal obstruction.