Open and Laparoscopic Procedures for SMA Syndrome



Open and Laparoscopic Procedures for SMA Syndrome


Markus W. Büchler

Thilo Welsch






Preoperative Planning

A detailed history (predisposing medical or surgical conditions, weight loss, epigastric pain, and conservative treatment strategies) and physical examination of the patient is mandatory in the preoperative setting. Patients who present with a history of characteristic symptoms suggesting SMA syndrome should undergo further radiographic studies
to establish the diagnosis. Upper gastrointestinal series, computed tomography (CT) scan or CT angiography, magnetic resonance (MR) angiography, conventional angiography, ultrasonography, and endoscopy have all been used for diagnosis. The following strict radiographic criteria have been established for diagnosis of the SMA syndrome by upper gastrointestinal series with contrast dye: (i) dilatation of the first and second parts of the duodenum, with or without gastric dilatation, (ii) abrupt vertical and oblique compression of the mucosal folds, (iii) antiperistaltic flow of contrast medium proximal to the obstruction, (iv) delay in transit of 4 to 6 hours through the gastroduodenal region, and (v) relief of obstruction in a prone, knee-chest or left lateral decubitus position.






Figure 34.2 The SMA leaves the aorta at an acute angle that is sustained by the left renal vein and the uncinate process of the pancreas embedded in retroperitoneal fat and lymph tissue. A low aortomesenteric angle can lead to vascular compression of the duodenum. A, SMA; B, aorta; C, third part of the duodenum; D, pancreas. Adapted from Welsch T, Buchler MW, Kienle P. (2007). Recalling superior mesenteric artery syndrome. Dig Surg. 24:149–156.








Table 34.1 Predisposing Conditions for Development of SMAS






































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Jun 15, 2016 | Posted by in GASTOINESTINAL SURGERY | Comments Off on Open and Laparoscopic Procedures for SMA Syndrome

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