Robot Strong Procedure for Superior Mesenteric Artery (Wilkie) Syndrome

Superior mesenteric artery (SMA) syndrome is a rare cause of proximal intestinal obstruction resulting from compression of the third portion of the duodenum between the aorta and the superior mesenteric artery. The Strong procedure offers a physiological alternative to duodenojejunostomy by performing full duodenal mobilization, thereby omitting the need for an intestinal bypass (e.g., duodenojejunostomy). We present the case of a woman with chronic postprandial abdominal pain, nausea, and bloating, refractory to conservative management. When the patient positioned herself in a left lateral fetal position, the complaints resolved. Preoperative imaging demonstrated a reduced SMA-aorta distance (8.1 mm) with a normal aortomesenteric angle (52.1°), as well as signs of duodenal stasis, all potentially consistent with SMA syndrome. The patient underwent a Robot Strong procedure consisting of division of the ligament of Treitz and full duodenal mobilization, including Kocherization. The postoperative course was uneventful. At 6 weeks of follow-up, symptoms were resolved completely, with improved oral intake. At imaging follow-up, the duodenum was placed more caudally, fitting with the expected outcome. These findings confirm the feasibility and clinical effectiveness of the Robot Strong procedure in highly selected patients with SMA syndrome.