Application of laparoscopic duodenojejunostomy for children with superior mesenteric artery syndrome

Objective To evaluate the efficacy of laparoscopic duodenojejunostomy for superior mesenteric artery syndrome (SMAS) in children. Methods Between 2015 to 2018, 4 SMAS children underwent laparoscopic duodenojejunostomy after a failure of conservative measures. For evaluating surgical efficacies, their clinical data and postoperative complications were recorded and analyzed. Results There were 1 boy and 3 girls. All of them were emaciated and slender. There was a sudden postprandial onset of bilious vomiting and abdominal pain. The average duration of illness was 1 month. Disturbances of water and electrolyte and malnutrition were quite common. However, symptomatic relief in knee-chest posture and wave of reverse peristalsis were not obvious. Their average weight at admission was 22.5 kg and body mass index (BMI) 14.2 kg/m2. Upper gastrointestinal radiography revealed obstruction of the third part of duodenum. And abdominal CT indicated an aortomesenteric angle of 13° and an aortomensenteric distance of 7 mm with gastric and proximal duodenal dilatation. If conservative measures failed, laparoscopic duodenojejunostomy was performed. The average operation time was 150 min. There were no postoperative complications such as obstruction, anastomotic leakage or anastomotic stenosis. Vomiting and abdominal pain were relieved. A month later, there was an average weight gain of 5.25 kg and BMI increased to 17.6 kg/m2. Conclusions Laparoscopic duodenojejunostomy is both simple and efficacious for SMAS with fewer postoperative complications and a lower recurrence rate in children. During operation, anastomosis should be large enough to avoid stenosis and anastomotic site should be close to obstruction site for reducing the length of non-functional bowel and lowering the incidence of blind loop syndrome. Key words: Child; Superior mesenteric artery syndrome; Laparoscopic duodenojejunostomy