Modified One Anastomosis Gastric Bypass (OAGB) Versus Duodenojejunostomy for Treatment of Superior Mesenteric Artery Syndrome: A Randomized Controlled Trial

BACKGROUND: Superior mesenteric artery syndrome is a rare cause of upper gastrointestinal obstruction. Surgical treatment is indicated when conservative measures fail; duodenojejunostomy is the most commonly performed procedure, although persistent or recurrent symptoms have been reported. We propose a modified one anastomosis gastric bypass (OAGB) as a functional reconstructive bypass to relieve duodenal obstruction. MATERIALS AND METHODS: This prospective randomized controlled trial included 20 patients with SMA syndrome, randomized equally to modified OAGB or duodenojejunostomy. Symptom severity and quality of life were assessed preoperatively and at 1, 3, 6, and 12 months. RESULTS: Modified OAGB resulted in higher WHOQOL-BREF scores at 12 months (59.3±10.0 vs. 42.7±15.9, P=0.014), lower rates of recurrent vomiting (20% vs. 50%), and shorter hospital stay (4.1±0.32 d vs. 6.8±2.94 d, P=0.017). CONCLUSION: Modified OAGB may represent a feasible and effective alternative to duodenojejunostomy for selected patients.