Question 1

Alvear Procedure - Duodenal Derotation with Duodenal Duodenostomy

Accepted Answer

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(https://doi.org/10.1177/000313480807400712)

Question 2

SMA transposition

Accepted Answer

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.

Question 3

Duodeno-jejunostomy (DJ)

Accepted Answer

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

Question 4

Duodenal Derotation

Accepted Answer

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.

Question 5

Gastro-jejunostomy

Accepted Answer

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.

Surgical Options for SMAS

Find a Doctor

Search by Location

Find a doctor near you with our comprehensive list submitted by patients.

Gastroenterologists

GI doctors provide diagnostic services, help with treatment, and feeding tube placement.

Surgeons

There are a variety of surgeries to treat SMAS. See a list of SMAS surgeons.

Get SMAS News