Laparoscopic Surgery Treatment On Superior Mesenteric Artery Compressing Syndrome

Background and ObjectiveSMACS(Superior mesenteric artery compressing syndrome,SMACS)is a series of motility disorders in the duodenum that is due to the horizontal part or the ascending part of duodenum being constricted by superior mesenteric artery or its branches,which further causes stasis and extension in the near end of duodenum.Postprandial abdominal pain and vomiting is its main symptom and it is intermittent.Taking left lateral position,knee-chest position or prone position may relieve the symptom and during the remittent stage,non-specific upper gastrointestinal symptoms may occur.Due to its low incidence rate,non-specific clinical manifestations and no standard diagnosis and treatment plan,patients with SMACS may be misdiagnosed and mistreated for a long term.Repeated occurrence of this disease may bring malnutrition,anemia,electrolyte metabolic disorders,and even mental neurological symptoms.In this article,it mainly discusses the diagnosis of SMACS and treatment experience of laparoscopic surgery.MethodsA retrospective analysis of clinical materials,treatment outcome and post-operation follow-up visits were conducted on 62 SMACS patients who had received total laparoscopy treatment from October 2006 to May 2016.ResultsAmong this group of patients,62 cases received upper gastrointestinal angiography and definite diagnosis was made on 51 cases;31 cases were diagnosed with the disease among 44 cases who had received CTA(computer tomography angiography,CTA)examination;26 cases were diagnosed with the disease among 38 cases who had received ultrasound examination.Among 62 cases,total laparoscopic duodenojejunostomy was conducted on 41 cases,total laparoscopic gastrointestinal anastomosis was conducted on 14 cases,total laparoscopic gastroduodenal double shortcut anastomosis was conducted on 7 cases.All patients were cured or alleviated and discharged from hospital.The total effect of postoperative follow-up was satisfying.ConclusionsThe preferred auxiliary method of SMACS diagnosis is upper gastrointestinal imaging while ultrasound or CTA can provide reference by measuring the inclined angle of abdominal aorta and superior mesenteric artery;as for the treatment,for patients with repeated occurrence and poor conservative treatment result,early operation is recommended.The total laparoscopic duodenojejunostomy as the main operation way.Laparoscopic surgery for treating SMACS is safe and reliable.