Study between Duodenojejunostomy and Roux-en-Y Gastrojejunostomy for Treatment of Superior Mesenteric Artery Syndrome: Meta Analysis

Abstract Background: Superior Mesenteric Artery (SMA) syndrome is a rare but serious condition characterized by the compres-sion of the third portion of the duodenum, leading to symptoms such as abdominal pain, vomiting, and malnutrition. Surgical intervention is often required when conservative treatments are ineffective. Aim of Study: To compare the outcomes of duodenojeju-nostomy and Roux-en-Y gastrojejunostomy in the treatment of SMA syndrome, focusing on their indications, efficacy, morbid-ity, and postoperative complications. Patients and Methods: The study were conducted follow-ing PRISMA guidelines to compare the outcomes of duode-nojejunostomy and Roux-en-Y gastrojejunostomy in patients diagnosed with Superior Mesenteric Artery (SMA) syndrome. The review included studies published in databases such as Pu-bMed, Cochrane Library, and EMBASE. Studies were selected based on predefined inclusion and exclusion criteria, focusing on patients aged 13 to 60 years with confirmed SMA syndrome. Data extraction was independently performed by two review-ers, and the quality of the included studies was assessed using the Modified Cowley’s criteria. Statistical analysis, including proportion meta-analysis, was conducted using Rstudio, with results synthesized quantitatively to evaluate the efficacy and safety of the surgical interventions. Results: After screening 1083 articles, 38 were included in the qualitative synthesis, and 13 were included in the quantita-tive synthesis and meta-analysis. The pooled safety outcome for duodenojejunostomy in patients with superior mesenteric artery syndrome was 0.89 (95% CI: 0.81–0.94), with minimal heterogeneity (I2=0%). Complications included angiostatin of the anastomosis, anastomotic edema, significant blood loss, and prolonged ileus. The pooled efficacy outcome was 0.84 (95% CI: 0.74–0.90), also with minimal heterogeneity (I2=0%). Some studies reported persistent symptoms, including unresolved nausea, vomiting, and epigastric pain. Risk of bias across stud-ies was low to moderate, with no significant publication bias detected (p-value >0.05). Conclusion: Duodenojejunostomy is a generally effective and safe treatment for Superior Mesenteric Artery syndrome, with high efficacy and safety outcomes. However, some pa-tients may experience persistent symptoms postoperatively. The study’s findings are robust, with low to moderate risk of bias and no significant publication bias. Further research compar-ing duodenojejunostomy with Roux-en-Y gastrojejunostomy is recommended to determine the optimal surgical approach.