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Laparoscopic Strong Procedure for Wilkie Syndrome (Complete Intestinal Derotation for SMA Syndrome)
Lilian Schwarz, Jeffrey Lee, Matthew H. Katz, Jason B. Fleming, Thomas Aloia, Jean-Nicolas Vauthey, Claudius Conrad^*

Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX

Background: Superior-Mesenteric-Artery-Syndrome is an ill characterized gastric-outlet-obstruction due to duodenal compression from decreased aortomesenteric space <10-20mm and angle <38-56°.
Patient: 18-year-old woman after ileocecectomy for appendiceal carcinoid. 12lbs weight loss due to postprandial abdominal pain. CT/upper-GI-series consistent with SMA-syndrome.
Result: Key steps of laparoscopic intestinal derotation are complete Kocherization, ligament of Treitz release, colonic medialization and bowel positioning in Ladds configuration.
Conclusion: If conservative management fails, (1) laparoscopic intestinal derotation can achieve symptom resolution while avoiding intestinal bypass and (2) minimal invasive approach is a revolution over traditional Strong procedure.

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