Outcomes of Laparoscopic Duodenal De-Rotation for Superior Mesenteric Artery Syndrome in Children

Background Superior mesenteric artery syndrome (SMAS) is a rare cause of duodenum obstruction, which affects the quality of life. Laparoscopic duodenal de-rotation has demonstrated short-term efficacy in case report. However, the characterization of intermediate-term outcomes remains limited. Objective Evaluate the intermediate-term efficacy of laparoscopic duodenal de-rotation by assessing symptom resolution. Method Between January 2016 and February 2025, patients diagnosed with SMAS who underwent laparoscopic duodenal de-rotation at the department of pediatric surgery at 2 tertiary children’s referral centers were reviewed. From 2016 to 2022, patient records were reviewed retrospectively, while patient data were collected prospectively starting in 2023. The symptoms, complications and Body mass index (BMI) were recorded. Results The study group included 7 boys (47%) and 8 girls (53%). Age ranged from 5 to 16 years (median, 13.3 years). All patients received conservative treatment, which lasted a median of 1 year. Patients underwent laparoscopic duodenal de-rotation without conversion. Patients were started on a clear liquid diet 2 days postoperatively, and mean length of hospital stay was 5.3 ± 1.9 days. With median follow-up time of 35 months, obstructive symptoms were complete relief in 5 patients (33%), and 9 patients (60%) showed improvement in their symptoms. BMI increased from median of 15.1 kg/m 2 (IQR 13.5-16.0) to 17.1 kg/m 2 (IQR 15.6-18.3) at the time of last follow-up. One required reoperation due to gastrointestinal dysmotility. Conclusion The laparoscopic duodenal de-rotation provides durable symptom improvement in most patients while avoiding the risk of anastomotic leakage.