Laparoscopic options in superior mesenteric artery syndrome in children: systematic review

Abstract

Superior mesenteric artery syndrome (SMAS) refers to the compression of the third portion of the duodenum between the aorta and the superior mesenteric artery, and usually results from weight loss or alteration in spine anatomy. This study reviewed laparoscopic options regarding SMA S in children. Methods MEDLINE/PubMed was reviewed. Studies in patients under 16 years of age and published in English/Spanish were included, and selected by two independent reviewers. Data were collected for age, gender, weight/body mass index, comorbidities, symptoms, surgical technique, complications, conversions, recurrence and mortality. Descriptive statistics were used to analyze the quantitative portion of the study, with results presented as percentages, means and medians. Results Twelve papers with n = 16 patients were included. Mean/median age were 10.7 and 13 years, respectively, with female predominance (n = 11, 68.75%). Emesis (n = 15, 93.75%) and abdominal pain (n = 11, 68.75%) were the most common symptoms. Anorexia nervosa was present in n = 1, and n = 1 patient had recent history of spinal fusion for idiopathic scoliosis. Regarding surgical technique, eleven cases consisted of duodenojejunostomy with side-to-side anastomosis (one associated with feeding jejunostomy); two Strong's procedures; and three Ladd's procedures. There were no conversions, and n = 2 (12.5%) minor complications (self-limited upper gastrointestinal bleed and persistence of vomiting for 48 h postoperatory). There was no mortality. Mean and median follow-up were 44.5 and 48 weeks, respectively, with no recurrences. Conclusions SMAS is uncommon in children. The preferred laparoscopic approach is duodenojejunostomy, which can provide definitive relief of the obstruction with minor complications and low recurrence.

Wilkie's syndrome in an adolescent female patient

“…18 The most common and successful operation for SMA syndrome is duodenojejunostomy, which was first proposed in 1907 by Bloodgood which can be done open or laparoscopically. [19][20][21] Patients are followed for resolution of their preoperative symptoms and weight gain is monitored.…”

Oclusión gastroduodenal crónica por síndrome de Wilkie: reporte de un caso

“…Existen varias soluciones quirúrgicas a realizarse tanto por vía convencional 5 como por vía mínimamente invasiva (laparoscópica y robótica) 2,3,12 y cada una con sus ventajas y desventajas asociadas. Los procedimientos más comunes son la duodenoyeyunostomía laterolateral 15,19 que presenta un éxito mayor al 90% tanto por vía convencional como por cirugía mínimamente invasiva 2,8,10,28 ; sus desventajas son fuga y estenosis de la sutura. Desrotación de duodeno (procedimiento de Strong) 15,12 , con un éxito mayor al 80%, sin pérdida de la continuidad intestinal pero con mayor riesgo de vólvulo duodenal en un 8% de pacientes.…”

“…El síndrome de Pinza Aortomesentérica o Síndrome de Wilkie es una entidad rara, caracterizada por la compresión de la tercera porción del duodeno entre la arteria mesentérica superior (AMS) y la aorta, lo cual genera una oclusión aguda o crónica, parcial o total [1][2][3] .…”

“…Para los casos crónicos, recurrentes o en los que falló el tratamiento médico está indicado el tratamiento quirúrgico, cuyo objetivo es restablecer la continuidad intestinal. Actualmente el procedimiento de elección es la derivación duodenoyeyunal con una tasa de éxito mayor al 90% 2,10 . El procedimiento puede realizarse por vía convencional o por mínimo acceso, éste último está tomando un papel fundamental en centros donde se posee la experiencia y tecnología necesarias 1,2,15,16 .…”