Robotic Roux-en-Y duodenojejunostomy for superior mesenteric artery syndrome: operative technique.

Abstract

BACKGROUND:

Superior mesenteric artery (SMA) syndrome, also known as Wilkie's syndrome, is a rare condition characterized by vascular compression of the duodenum that leads to intestinal obstruction. While there have been a few recent case reports of laparoscopic duodenojejunostomy performed as an option for surgical treatment, the role of the da Vinci(®) robot in superior mesenteric syndrome has been underestimated. The authors report a robotic Roux-en-Y duodenojejunostomy for the treatment of SMA syndrome.

MATERIALS AND METHODS:

A 39-year-old man with a history of Amyotrophic lateral sclerosis presented with an upper gastrointestinal obstruction with distended abdomen. A computed tomography scan showed a transition in the third portion of the duodenum where the SMA vessels crossed over, with a decompressed jejunum. He was identified as a candidate for a duodenojejunostomy. The da Vinci Surgical System was used to mobilize the colon and duodenum, and a Roux-en-Y duodenojejunostomy was performed with hand-sewn anastomosis.

RESULTS:

There were no intraoperative complications. The blood loss was minimal and operative time was 120 minutes. The postoperative course was uneventful with resolution of intestinal obstruction.

CONCLUSION:

Robotic Roux-en-Y duodenojejunostomy as a surgical option for treatment of SMA syndrome is safe, feasible, and a valid alternative to open surgery with the added benefits of a minimally invasive approach.

• Authors: Subhashini M Ayloo, Mario A Masrur, Francesco M Bianco, Pier C Giulianotti
• Journal: Journal of laparoendoscopic & advanced surgical techniques. Part A (J Laparoendosc Adv Surg Tech A) Vol. 21 Issue 9 Pg. 841-4 (Nov 2011) ISSN: 1557-9034 [Electronic] United States
• PMID: 21819217 (Publication Type: Case Reports, Journal Article)

Topics

• Adult
• Anastomosis, Roux-en-Y (methods)
• Blood Loss, Surgical
• Duodenostomy (methods)
• Duodenum (diagnostic imaging, surgery)
• Humans
• Jejunostomy (methods)
• Male
• Robotics (methods)
• Superior Mesenteric Artery Syndrome (surgery)
• Tomography, X-Ray Computed