Medium-term results of laparoscopic lateral duodenojejunostomy for pediatric superior mesenteric artery compression syndrome

Abstract

Purpose: Laparoscopic lateral duodenojejunostomy (LLD) has been shown to be feasible in some reported cases for pediatric Wilkie’s syndrome, also known as superior mesenteric artery compression syndrome (SMAS), but its medium-term outcomes are lacking. We summarized the experience of LLD for SMAS in children, aiming to confirm its effectiveness. Methods: From January 2013 to May 2021, SMAS children who received LLDwere included in this retrospective study. The procedure was carried out utilizing the four-trocar technique. The elevation of the transverse colon allows good exposure of the dilated and bulging second and third sections of the duodenum. Using a linear stapler, we established a lateral anastomosis connecting the proximal jejunum with the third part of duodenum. Following that, a running suture was used to intracorporeally close the common enterotomy. Clinical data on patients was collected for analysis. Results: We retrospectively analyzed 9 SMAS patients (6 females and 3 males) who underwent LLD, aged between 7 and 17 years old. The mean operative time was 118.4±16.5 min and mean estimated blood loss was 5.6±1.4 ml. There was no conversion, intraoperative complications or immediate postoperative complications. The mean postoperative hospital stay was 6.8 days. During follow-up (20 months), seven patients experienced complete recovery of symptoms prior to surgery. One patient still had mild vomiting, which resolved with medication. Another patient developed psychological nausea, which significantly improved after treatment with education and diet management. Conclusions: LLD represents a feasible and effective treatment option for SMAS in well-selected children, providing favorable medium-term outcomes.