The duodenum is untwisted and relocated out from between the SMA and Aorta thus alleviating the compression. The intestine is secured to the right side of the body and a duodenal duodenostomy is preformed. The third and forth section of the duodenum are resected to repair the compressed area.

Why is this surgery the best option?

1) It resolves the intestinal compression which is a major cause of pain in patients

2) Patients retain the majority of their nutritional absorption because the 3rd and 4th portion of the duodenum are not being bypassed like a DJ or GJ surgery

3) Risk of developing SIBO is minimal because the compressed portion no longer exists while it still remains from DJ and GJ surgeries

Study from 1974 - 2001:

https://doi.org/10.1177/000313480807400712

The Superior Mesenteric Artery (SMA) is disconnected from the Abdominal Aorta (AA) and reattached again below the left renal vein and the third portion of the duodenum.

A surgical operation that joins part of the duodenum and the jejunum with creation of an artificial opening between them.

Is a procedure where the ligament of Treitz is divided and the duodeno-jejunal junction (DJ) is rotated away from the SMA and sutured to the right abdominal wall.

A gastrojejunostomy is a surgical procedure that creates an anastomosis between the stomach and the jejunum. It can be performed in either a hand-sewn or a stapled fashion, either open or laparoscopically. Some centers have even created gastrojejunostomies endoscopically.