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General and digestive surgery

Find all the surgical interventions, lectures, experts opinions, debates, webinars and operative techniques per specialty.
Wilkie's syndrome surgery
Wilkie’s syndrome (or superior mesenteric artery syndrome) was first described by Von Rokitansky in 1861. It consists in an extrinsic pressure over the third duodenal portion originating from an uncertain cause. Wilkie found a decreased angle (25 degrees, or less) between the superior mesenteric artery and the aorta, conditioning a duodenal (3rd portion) obstruction of vascular origin. It is associated with weight loss. The real incidence remains unknown due to the lack of diagnosis. However, the estimated incidence varies between 0.013 to 1% of the population. The male/female ratio is 2:3, ranging age between 10 and 39 years old.
Symptoms include postprandial abdominal pain, nausea and vomiting, weight loss, early gastric fullness and anorexia (acute high gastroduodenal obstruction).
Diagnostic studies include barium esophageal gastroduodenal series, CT-scan, MRI, high endoscopy (peptic esophagitis, ulcer). Endoscopic studies must come together with barium esophageal gastroduodenal X-ray studies.
Surgical treatment is performed when there is no response to medical treatment, consisting in duodenojejunal anastomoses, with Treitz’s ligament division. Gastrojejunal anastomosis is an alternative option. Laparoscopic surgical treatment can be performed.
G Lozano Dubernard, R Gil-Ortiz Mejía, B Rueda Torres
Surgical intervention
3 months ago
987 views
5 likes
1 comment
13:16
Wilkie's syndrome surgery
Wilkie’s syndrome (or superior mesenteric artery syndrome) was first described by Von Rokitansky in 1861. It consists in an extrinsic pressure over the third duodenal portion originating from an uncertain cause. Wilkie found a decreased angle (25 degrees, or less) between the superior mesenteric artery and the aorta, conditioning a duodenal (3rd portion) obstruction of vascular origin. It is associated with weight loss. The real incidence remains unknown due to the lack of diagnosis. However, the estimated incidence varies between 0.013 to 1% of the population. The male/female ratio is 2:3, ranging age between 10 and 39 years old.
Symptoms include postprandial abdominal pain, nausea and vomiting, weight loss, early gastric fullness and anorexia (acute high gastroduodenal obstruction).
Diagnostic studies include barium esophageal gastroduodenal series, CT-scan, MRI, high endoscopy (peptic esophagitis, ulcer). Endoscopic studies must come together with barium esophageal gastroduodenal X-ray studies.
Surgical treatment is performed when there is no response to medical treatment, consisting in duodenojejunal anastomoses, with Treitz’s ligament division. Gastrojejunal anastomosis is an alternative option. Laparoscopic surgical treatment can be performed.
Laparoscopic duodenojejunostomy for superior mesenteric artery syndrome
Purpose:
The superior mesenteric artery (SMA) syndrome is a rare disease in which the third portion of the duodenum is compressed by the narrow space of the SMA and the aorta. Surgical treatment such as duodenojejunostomy (DJS) could resolve this problem. Here we report our experience of laparoscopic DJS with a video demonstration.

Materials and Methods:
This 18-year-old woman suffered from vomiting, abdominal distention and progressive weight loss during 6 months before admission. The abdominal discomfort usually occurred after meals and it could be alleviated by a decubitus position. Endoscopic exams revealed gastritis and reflux esophagitis. Computed tomography (CT) with contrast identified the distended stomach and the proximal duodenum obstructed by the SMA. Surgical treatment was advised after a complete preoperative survey, including a series of image survey, psychological evaluation and nutrition status. A three-port laparoscopic approach was used. After opening a small window through the mesocolon, a side-to-side DJS was created with a linear stapler and the common channel was closed with a hand-sewn suture.

Results:
There were no intraoperative complications. The laparoscopic DJS tooks 52 mins and blood loss was minimal. The nasogastric tube was removed on postoperative day 3 and she was discharged uneventfully on postoperative day 7. The postoperative upper GI series showed a smooth contrast passage from the DJS to the intestine and the patient gained 6 kg within 4 months after surgery.

Conclusion:
Laparoscopic DJS is a surgical option for SMA syndrome after conservative treatment failure. It is safe, feasible and provides the benefits of a minimally invasive approach.
CH Hsu, KH Liu, CY Tsai, TS Yeh
Surgical intervention
3 years ago
1892 views
65 likes
0 comments
08:42
Laparoscopic duodenojejunostomy for superior mesenteric artery syndrome
Purpose:
The superior mesenteric artery (SMA) syndrome is a rare disease in which the third portion of the duodenum is compressed by the narrow space of the SMA and the aorta. Surgical treatment such as duodenojejunostomy (DJS) could resolve this problem. Here we report our experience of laparoscopic DJS with a video demonstration.

Materials and Methods:
This 18-year-old woman suffered from vomiting, abdominal distention and progressive weight loss during 6 months before admission. The abdominal discomfort usually occurred after meals and it could be alleviated by a decubitus position. Endoscopic exams revealed gastritis and reflux esophagitis. Computed tomography (CT) with contrast identified the distended stomach and the proximal duodenum obstructed by the SMA. Surgical treatment was advised after a complete preoperative survey, including a series of image survey, psychological evaluation and nutrition status. A three-port laparoscopic approach was used. After opening a small window through the mesocolon, a side-to-side DJS was created with a linear stapler and the common channel was closed with a hand-sewn suture.

Results:
There were no intraoperative complications. The laparoscopic DJS tooks 52 mins and blood loss was minimal. The nasogastric tube was removed on postoperative day 3 and she was discharged uneventfully on postoperative day 7. The postoperative upper GI series showed a smooth contrast passage from the DJS to the intestine and the patient gained 6 kg within 4 months after surgery.

Conclusion:
Laparoscopic DJS is a surgical option for SMA syndrome after conservative treatment failure. It is safe, feasible and provides the benefits of a minimally invasive approach.
Laparoscopic duodenal derotation due to superior mesenteric artery syndrome
Introduction: Wilkie’s Syndrome, also called the Superior Mesenteric Artery Syndrome (SMA) is a clinical entity characterized by compression of the 3rd portion of the duodenum between the aorta and the emergence of the SMA. It is a rare cause of duodenal obstruction with around 400 cases reported in the literature.
Methods: this video illustrates the case of a 50 year-old patient with a history of ankylosing spondylitis and cholecystectomy by laparotomy. She was admitted at the Emergency Room with a story suggestive of high intestinal obstruction. During hospitalization, a CT-scan was performed suggesting the existence of a mesenteric clamp. This etiology was confirmed after evaluation of the abdomen with Magnetic Resonance Imaging the next day.
Results: the patient was subjected to a laparoscopic duodenal derotation, with resolution of clinical symptoms.
Conclusions: duodenal derotation can be sufficient to treat this pathology. The laparoscopic approach, when performed by an experienced laparoscopic surgeon and using the same principles of laparotomy, should be preferred. It allows a better visualization of anatomical structures and a better patient recovery.
M Nora, G Gonçalves, T Ferreira
Surgical intervention
7 years ago
3733 views
61 likes
2 comments
06:57
Laparoscopic duodenal derotation due to superior mesenteric artery syndrome
Introduction: Wilkie’s Syndrome, also called the Superior Mesenteric Artery Syndrome (SMA) is a clinical entity characterized by compression of the 3rd portion of the duodenum between the aorta and the emergence of the SMA. It is a rare cause of duodenal obstruction with around 400 cases reported in the literature.
Methods: this video illustrates the case of a 50 year-old patient with a history of ankylosing spondylitis and cholecystectomy by laparotomy. She was admitted at the Emergency Room with a story suggestive of high intestinal obstruction. During hospitalization, a CT-scan was performed suggesting the existence of a mesenteric clamp. This etiology was confirmed after evaluation of the abdomen with Magnetic Resonance Imaging the next day.
Results: the patient was subjected to a laparoscopic duodenal derotation, with resolution of clinical symptoms.
Conclusions: duodenal derotation can be sufficient to treat this pathology. The laparoscopic approach, when performed by an experienced laparoscopic surgeon and using the same principles of laparotomy, should be preferred. It allows a better visualization of anatomical structures and a better patient recovery.