Superior mesenteric artery syndrome requires surgical intervention when conservative therapies have failed. The protocol below outlines the evidence-based surgical approach for this indication.

Treatment Approach

Surgical therapy is recommended when conservative management has not been sufficient—particularly in patients with a long history of the condition, immobility, prior abdominal operations, or vascular involvement. The protocol describes a range of surgical procedures for this indication; laparoscopic techniques are among those covered and are widely preferred for their established safety profile. The complete procedure-selection guidance, including newer endoscopic alternatives, is detailed in the full structured protocol.

References

DOI: 10.12998/wjcc.v11.i15.3369

Surgical therapy, however, can be recommended if conservative therapies fail especially in elder patients with multiple abdominal operation histories, immobility (bed rest), long history of SMA syndrome and arteriosclerosis of SMA.
Various surgical procedures include laparoscopic, laparotomic, or robotic gastrojejunostomy, gastroduodenostomy and duodenojejunostomy, Strong's procedure (a division of the ligament of Treitz), anterior transposition of the third part of duodenum, duodenal lowering, Ladd's procedure, and transabdominal duodenojejunostomy.
Since 1998, when the first successful laparoscopic duodenojejunostomy was performed, most surgeons prefer laparoscopic duodenojejunostomy because of its safety and effectiveness (success rates: 80%-100%).
Most recently, a new technique of endoscopic gastrojejunostomy (so called lumen-apposing metal stent) has also been reported in several case reports as a safe and effective therapeutic option.

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Surgical Management of Superior Mesenteric Artery Syndrome

Treatment Approach

References