Duodenojejunostomy is a surgical approach to treat superior mesenteric artery syndrome.

May 30, 2022

Duodenojejunostomy is a surgical approach to treat superior mesenteric artery syndrome, in which the compressed portion of the duodenum is released and an anastomosis is created between the duodenum and jejunum anterior to the superior mesenteric artery.

Some facts about Duodenojejunostomy: 

  • Vascular compression of the duodenum can be treated with laparoscopic duodenojejunostomy while preserving the benefits of minimally invasive surgical techniques in the debilitated patient.
  • Superior mesenteric artery (SMA) syndrome is a rare form of small bowel obstruction in which the third portion of the duodenum is compressed between the SMA anteriorly and the aorta posteriorly causing duodenal obstruction.
  • Abdominal pain, fullness, nausea, vomiting, and/or weight loss are the symptoms of SMA which is due to loss of the fatty tissue that surrounds the superior mesenteric artery.
  • Significant weight loss caused by medical disorders, psychological disorders, or surgery are the most common cause of it.
  • Nutritional optimization with tube feeds distal to the site of obstruction is the firstline treatment for Duodenal obstruction as it is often get resolved with distal tube feeds. But, a surgical bypass is required when patients fail this medical management.
  • A Doppler ultrasound investigation of abdominal vessels can be done for diagnosing SMA.
  • Contrast-enhanced computed tomography and magnetic resonance imaging may be done to assess the aortomesenteric angle and distance.

Preparation for Duodenojejunostomy: 

  • Medical history of the patient will be taken by asking questions about current symptoms, past medical history, medications, allergies, the patient\\\\\\\'s social history, and medical history of the family.
  • Medications containing aspirin or ibuprofen (Advil, Motrin IB, others) should be stopped before and after surgery as these medications may increase bleeding.
  • Smoking should be stopped as smoking can increase your risk of having problems during and after surgery and also can slow the healing process.
  • You should not eat or drink anything after midnight, the night before surgery. 

Procedure for Duodenojejunostomy: 

  • The part of the duodenum and the jejunum will be joined with creation of an artificial opening between them in this procedure.
  • The obstruction or a duodenal derotation procedure will be bypassed to alter the aortomesenteric angle and place the third and fourth portions of the duodenum to the right of the superior mesentericartery.
  • Veress needle technique is used to establish Pneumoperitoneum.
  • A port will be first inserted at the umbilicus for a 30 degree telescope. Then a port in the epigastrium for liver retraction, another port in the right lumbar area for a left-hand working port, and a port in the left lumbar area for a right-hand working port will be inserted.
  • The dilated, bulging second and third parts of the duodenum will be exposed by lifting the transverse colon.
  • The second and third parts of the duodenum found in the infracolic compartment extending down to the level of the ileocecal junction due to distension of the duodenum rather than to a congenital anomaly
  • The visceral peritoneum covering this area will be cut with scissors, and this part of the duodenum will be freely mobilized.
  • A loop of jejunum about 7 cm to 10 cm will be brought up to the duodenum from the duodenojejunal flexure.
  • Stay sutures will be applied intracorporeally and a small opening of about 1 cm will be made in both the duodenum and jejunum.
  • One of the jaws will be introduced into the lumen of the jejunum, and the other jaw was introduced into the lumen of the duodenum. The stapler was then fired. 
  • Vicryl sutures in a single layer will be used to close the common opening.