metricas
covid
Buscar en
Cirugía Española (English Edition)
Toda la web
Inicio Cirugía Española (English Edition) Is the single-incision laparoscopic duodenojejunostomy factible, safe and effect...
Información de la revista
Vol. 100. Núm. 7.
Páginas 450-452 (julio 2022)
Vol. 100. Núm. 7.
Páginas 450-452 (julio 2022)
Scientific letter
Acceso a texto completo
Is the single-incision laparoscopic duodenojejunostomy factible, safe and effective for patients with Wilkie's syndrome?
¿Es factible, segura y eficaz la duodenoyeyunostomía laparoscópica por puerto único para el tratamiento del síndrome de Wilkie?
Visitas
373
Sandra Dios-Barbeito
Autor para correspondencia
sandra_dios89@hotmail.com

Corresponding author.
, Francisco López-Bernal, Francisco Moreno-Suero, Salvador Morales-Conde
Cirugía General y del Aparato Digestivo, Hospital Universitario Virgen del Rocío, Sevilla, Spain
Este artículo ha recibido
Información del artículo
Texto completo
Bibliografía
Descargar PDF
Estadísticas
Texto completo

Superior mesenteric artery (SMA) syndrome or Wilkie’s syndrome causes intestinal obstruction by compression of the third duodenal portion between the aorta and the SMA and, although rare, can be the origin of any condition associated with weight loss. Treatment includes medical management for uncomplicated cases, leaving the surgical option for those that are chronic or refractory.1

We reviewed patients treated at our hospital by single-port laparoscopic duodenojejunostomy for SMA syndrome refractory to medical treatment between July 2013 and November 2015, and collected demographic, clinical, and imaging data (Table 1).

Table 1.

Demographic and clinical presentation data.

Case  Age  Sex  Symptoms and duration (months)  Emergency department attendance (n°)  Weight loss (kg)  BMI at diagnosis (kg/m2GDS  UGE  CT  Aorto-mesenteric angle (degrees) 
23  Female  Abdominal pain, vomiting; 12 months  19.95  Yes  Not diagnostic  Yes  21 
41  Female  Abdominal pain; 35 months  –  17.01  Not diagnostic  Not diagnostic  Yes  24 

We included two women, median age 32 years (23–41) with upper abdominal pain, associated in one of the women with vomiting and acute weight loss (2 kg), and a median duration of 23.5 months (12–35 months).

Diagnosis was based on clinical findings and complementary tests, by gastroduodenal study (GDS), upper gastrointestinal endoscopy (UGE), and computed tomography (CT). UGE was not diagnostic in either case, whereas the first case was suspected after GDS. The key to diagnosis was CT, which showed a reduced aortomesenteric angle in both patients (median 22.5°).

The surgical technique used a single-port laparoscopic approach, starting with exposure of the third duodenal portion and the creation of a mechanical isoperistaltic laterolateral intracorporeal anastomosis between it and a loop of jejunum at 30cm from the angle of Treitz. Tightness was checked by methylene blue via nasogastric tube and no significant blood loss was described, with a median operating time of 62.5 min (55−70 min). All the patients were mobilised early, diet was started on the second postoperative day and the median hospital stay was 4 days (2–6 days). After a median follow-up of 158 months (65–93), the symptoms of both patients had resolved, and they had gained weight. The surgical and treatment efficacy data are shown in Table 2.

Table 2.

Surgical and treatment efficacy data.

Case  Operating time (min)  Blood loss (ml)  Hospital stay (days)  Follow-up (months)  Clinical resolution  BMI post-surgery (5 years) (kg/m2
70  93  Yes  21.6 
55  65  Yes  18.4 

Wilkie’s syndrome is caused by compression of the third duodenal portion, when the angle between the aorta and the SMA is less than 25°, consistent with the findings in our series. It is thought to be due to rapid weight loss leading to a reduction in mesenteric fat around the aorta and SMA, although in up to 40% of patients it has no explainable cause.2 Our sample consisted of young women, as described in the literature.

This entity may present acutely or, more frequently, as chronic intermittent compression of the duodenum leading to symptoms such as abdominal pain, nausea, vomiting, weight loss, or early satiety, which are relieved by lateral or prone decubitus by increasing the aortomesenteric distance. In our series, both patients presented with upper abdominal pain, associated in one of the women with vomiting and acute weight loss.

Diagnosis requires a high index of suspicion and detailed radiological evaluation. UGE may show extrinsic duodenal compression and exclude mechanical causes of obstruction, whereas GDS may reveal proximal dilatation. However, the key to diagnosis is visualisation of a narrow aortomesenteric angle on sagittal CT3 reconstruction, which confirmed the diagnosis in our two patients and ruled out other associated syndromes, such as arcuate ligament or nutcracker syndrome.

Medical management is the mainstay of treatment in uncomplicated cases, with strict diet, nasogastric tube, rehydration, and water and electrolyte correction, which may be helped by placing the patient in prone or left lateral decubitus. Surgical treatment should be chosen in the event of complications or lack of response to treatment after 6–8 weeks,4 and open or laparoscopic gastrojejunostomy or duodenojejunostomy have been most frequently described. The single-port laparoscopic approach performed by surgeons with experience in minimally invasive surgery had good results in our series, with short operating times, no significant perioperative complications, less postoperative analgesic requirements and rapid recovery.5 In our series, hospital stay was shorter than that described in the literature for the open approach and there was an earlier return to activities of daily living.6 Surgical treatment is effective in most cases,7–9 which was also confirmed in our series.

To conclude, the single-port laparoscopic approach to SMA syndrome appears feasible, safe, and effective in the long term, with short hospital stays, few complications and good long-term results when performed by experienced surgeons.

Funding

We received no funding for this paper.

References
[1]
C. Palanivelu, M. Rangarajan, R. Senthilkumar, R. Parthasarathi, K. Jani.
Laparoscopic duodenojejunostomy for superior mesenteric artery syndrome.
JSLS [Internet], 10 (2006), pp. 531-534
[2]
A. Alvarenga, C. Espinheira, P. Guerra, M. Garcia, M. Abreu, M. Campos.
Superior mesenteric artery syndrome: weight loss can be a problem, weight gain can be a solution.
GE - Port J Gastroenterol [Internet], 24 (2017), pp. 43-46
[3]
M.E. Rabie, O. Ogunbiyi, A.S. Al Qahtani, S.B.M. Taha, A. El Hadad, I. El Hakeem.
Superior mesenteric artery syndrome: clinical and radiological considerations.
Surg Res Pract [Internet], 2015 (2015), pp. 1-5
[4]
Y. Khodear, W. Al-Ramli, Z. Bodnar.
Laparoscopic management of a complicated case of Wilkie’s syndrome: a case report.
Int J Surg Case Rep [Internet], 37 (2017), pp. 177-179
[5]
S. Kim, Y.S. Kim, Y. Min.
SMA syndrome treated by single incision laparoscopic duodenojejunostomy.
Clin Med Insights Case Rep, (2014), pp. 87-89
[6]
F. Bohanon, O. Nunez Lopez, B. Graham, L. Griffin, R. Radhakrishnan.
A case series of laparoscopic duodenojejunostomy for the treatment of pediatric superior mesenteric artery syndrome.
Int J Surg Res, S1 (2016), pp. 1-5
[7]
G. Valiathan, M. Wani, J. Lanker, P.K. Reddy.
A case series on superior mesenteric artery syndrome surgical management, single institution experience.
J Clin Diagn Res, 11 (2017), pp. 11-13
[8]
Magee G, Slater BJ, Lee JT, Poultsides GA. Laparoscopic duodenojejunostomy for superior mesenteric artery syndrome. 2011;2528–2531.
[9]
R.M. Singaporewalla, D. Lomato, T.K. Ti.
Laparoscopic duodenojejunostomy for superior mesenteric artery syndrome.
JSLS [Internet], 13 (2009), pp. 450-454

Please cite this article as: Dios-Barbeito S, López-Bernal F, Moreno-Suero F, Morales-Conde S. ¿Es factible, segura y eficaz la duodenoyeyunostomía laparoscópica por puerto único para el tratamiento del síndrome de Wilkie? Cir Esp. 2022;100:450–452.

Copyright © 2021. AEC
Descargar PDF
Opciones de artículo
es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos

Quizás le interese:
10.1016/j.cireng.2024.05.011
No mostrar más