Living with superior mesenteric artery syndrome, also known as SMA syndrome, can feel like being trapped in a cycle of discomfort and frustration. Though it’s an uncommon digestive syndrome, it can be a disruptive digestive condition for those who suffer from it. 

While doctors typically begin with conservative approaches like nutritional support and positioning changes, these methods don't work for everyone. When non-surgical treatments fail to provide relief, understanding your surgical options is essential for reclaiming your digestive health and quality of life. 

Read on to learn what to expect before, during, and after SMA syndrome surgery from the best SMA treatment specialist in Los Angeles. 

When is Surgery Necessary for SMA Syndrome?

Typically, surgery for SMA syndrome becomes necessary when conservative treatments fail to provide relief. Additionally, digestive specialists may recommend surgical intervention when patients continue to experience significant weight loss, persistent vomiting, severe malnutrition, or intolerable pain despite attempts at nutritional therapy, positional changes, and medication. The inability to maintain adequate nutrition through oral or tube feeding is a critical turning point in treatment decisions. 

Delaying SMA surgery, when recommended by a doctor, carries substantial risks. Some of these risks include:

  • Dangerous electrolyte imbalances
  • Progressive malnutrition, leading to muscle atrophy
  • Potential complications like aspiration pneumonia from chronic vomiting

In severe cases, postponing surgical treatment can lead to complete duodenal obstruction, perforation, or life-threatening metabolic disorders that require emergency intervention. Young adults with dramatic weight loss and those with anatomical factors that worsen the arterial compression are particularly vulnerable to these complications if surgical treatment is unnecessarily delayed.

Types of Surgical Procedures for SMA Syndrome

Surgeons typically choose between three main surgical procedures when treating SMA syndrome, each with specific benefits depending on the patient's condition and severity of duodenal compression: 

  • Duodenal Derotation Procedure: Repositions the duodenum to relieve compression and restore digestive flow.
  • Duodenojejunal Bypass: Creates a new connection to bypass the compressed duodenum and restore digestion.
  • The Strong Procedure: Releases the ligament of Treitz to reposition the duodenum and relieve artery compression.

In some complex cases, surgeons might combine these approaches or use minimally invasive laparoscopic techniques that require smaller incisions. These techniques usually lead to faster recovery times and less post-operative pain.

Preparation for SMA Syndrome Surgery

Preparing for SMA syndrome surgery requires several important steps to maximize your chances of a successful outcome. Your medical team will guide you through this process, which typically includes:

  • Complete preoperative assessments: This includes blood tests, imaging studies like CT scans or MRIs, and cardiovascular evaluations to confirm your diagnosis and assess your overall health. 
  • Focus on nutritional improvement: Since malnutrition is common with SMA syndrome, doctors often recommend improving your nutritional status before surgery through temporary feeding tubes, intravenous nutrition (TPN), or carefully planned high-calorie diets. For some patients, weight gain can help improve the mesenteric fat pad, increasing the odds of a successful treatment. 
  • Anesthesia and pain management planning: During pre-surgical consultations, your anesthesiologist will review your medical history, discuss the anesthesia plan, and address any concerns you might have about pain management. They'll also explain options for controlling post-operative pain, which may include patient-controlled analgesia (PCA) pumps, nerve blocks, or oral medications.
  • Prepare your home for recovery: Set up a dedicated recovery area with easy access to a bathroom. Have a place for essential items like medications, water, phone, and remote within arm's reach. Stock up on approved post-surgery foods and easily prepared meals, which may include clear liquids or soft, bland foods for the first few days after SMA surgery. Lastly, you’ll want to recruit someone to stay with you for at least the first few days after hospital discharge.

After SMA Syndrome Surgery

Once the SMA syndrome surgical procedure is complete, patients typically spend a night or two in the hospital, where medical staff closely monitor vital signs, incision healing, and the return of normal bowel function. 

  • During the first one to two days, you'll likely receive intravenous fluids and pain medication while your digestive system begins to wake up from surgery. 
  • Once your surgeon hears bowel sounds and you pass gas, you'll start a carefully planned dietary progression. This usually begins with clear liquids, advancing to full liquids, then soft foods, and finally, regular meals as tolerated. 
  • Some patients may need temporary nutritional support through feeding tubes or IV nutrition if eating remains challenging. 
  • Physical activity usually starts with simple movements like getting out of bed with assistance on the first day after surgery. It is followed by short walks around the hospital floor that gradually increase in distance.

Most patients can return to desk work within two to four weeks, though full recovery and adjustment to the surgical changes may take two to three months as your body adapts to its new gastrointestinal tract.

Where to Find the Best SMA Syndrome Surgeon in Los Angeles

When facing SMA syndrome surgery, you need the best superior mesenteric artery syndrome surgeon in Los Angeles who combines technical skill with a genuine understanding of the digestive tract and this rare condition's impact on your life. Dr. Danny Shouhed brings board-certified expertise in gastrointestinal surgery alongside specialized knowledge of the precise anatomical adjustments needed to relieve SMA symptoms. 

Whether you’ve exhausted conservative treatments without relief, have a new SMA syndrome diagnosis, or are wondering if you have SMA syndrome, our clinic provides a comprehensive understanding of the challenging SMA syndrome journey with personalized treatment plans, including surgical intervention when necessary. 

Ready for a personalized surgical approach that addresses your unique circumstances from the best SMA doctor in Los Angeles?