Long-term outcomes of laparoscopic duodenojejunostomy for superior mesenteric artery syndrome

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/m² (IQR 17.8-21.1) to 21.6 kg/m² (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.