Superior mesenteric artery syndrome (SMAS) is a rare condition that happens when portions of the duodenum, the first part of the small intestine, get pinched between two major arteries, the aorta and the superior mesenteric artery. Food struggles to pass, which leads to early satiety, nausea, vomiting, pain after meals, significant weight loss, and a decrease in quality of life. When nutrition support no longer helps, surgery becomes the next step. The type of operation your surgeon chooses can shape everything from your recovery to the outcome.

For those looking for the best SMA syndrome treatment specialist in Beverly Hills, knowing how each surgery works makes it easier to compare surgeons. Read on to understand the top three SMAS treatment procedures and which one may be right for you. 

When is SMAS Surgery Really Necessary?

In some cases of SMA syndrome, rebuilding the fat pad between the two arteries with tube feeding or IV nutrition can relieve the pressure. However, long-standing SMAS tends to behave differently. This is likely because the duodenum can scar and narrow at the point of compression, so it stays blocked even after weight returns. When symptoms continue despite steady nutrition, surgical intervention is usually the most effective treatment. If SMAS surgery is in your future, a surgeon can use three specific approaches. 

The Strong Procedure

The Strong procedure frees the duodenum by cutting the ligament of Treitz, the band that holds it in place, and then lowers the intestine away from the artery. It is the least invasive option because the surgeon does not cut or reconnect the bowel. The tradeoff is reliability. Case reports find the Strong procedure fails in around 25% of patients, especially when scar tissue holds the duodenum in place. Yet, some surgeons still offer it to patients with milder disease who want to avoid a larger operation.

Duodenojejunostomy

A duodenojejunostomy creates a bypass by connecting the swollen duodenum to the jejunum, a lower section of the small intestine, so food can skip the pinched area. Surgeons have used it for decades. The compressed segment stays in place, though, and it can turn into a blind loop where food and bacteria collect. 

Duodenal Derotation With Duodenoduodenostomy

Duodenal derotation moves the duodenum and small intestine to the right side of the abdomen, so the duodenum no longer passes under the artery at all. A duodenoduodenostomy then connects two healthy sections of the duodenum to bypass any scarred segment.

What to Expect When Recovering From SMA Syndrome Surgery

SMA syndrome surgery asks more of the body than many abdominal operations because most patients arrive underweight and depleted. After surgery, you can expect: 

  • A slow return of bowel function in the first several days
  • A feeding tube for extra nutrition while the intestine heals
  • IV nutrition through a PICC line at discharge for some patients
  • Steady weight gain over the following months

Questions to Ask When Searching for the Best SMA Syndrome Treatment Doctor in Los Angeles 

Patients looking for the best SMA syndrome treatment doctor can use these questions to compare surgeons:

  • Which operation do you recommend for my case, and why?
  • How many duodenal derotations have you performed?
  • Have you checked me for median arcuate ligament syndrome (MALS)? 
  • How will you rule out gastroparesis and other motility problems?
  • What is the nutrition plan before and after surgery?
  • What are your success rates?

The MALS question deserves special attention because MALS pain is often located in the upper middle abdomen and starts right after eating. SMAS pain tends to sit around the belly button, comes in cramps, and begins later after a meal. Many patients have both, and treating one while missing the other can leave symptoms behind.

Choosing the Best SMA Syndrome Treatment Specialist for You

As Cedars-Sinai's highest-volume robotic surgeon, Dr. Danny Shouhed performs complex operations through small incisions. When MALS and SMAS treatment are needed together, he can treat both in the same surgery. We plan every case around nutrition, from building strength before surgery to arranging tube feeding and IV support after discharge. Additionally, our team coordinates with your local doctors so care continues once you return home.

Patients nationwide who are looking for the best SMA syndrome treatment specialist can schedule a virtual consultation with our Beverly Hills office from anywhere. Ready to get an expert surgical treatment plan for your SMA symptoms?