Purpose Superior mesenteric artery (SMA) syndrome (Wilkie’s)- is a known sequel to mechanical obstruction of the third part of the duodenum by the SMA. This is mainly from loss of the mesenteric fat pad around this vessel, causing a nutcracker effect that requires urgent input. Surgical techniques to manage the obstruction have varied, yet the most practical and effective is bypassing the obstruction itself laparoscopically. Methods A case series of five patients is described. Three were males, aged between 18 and 50 years.Three had underlying chronic psychological issues. Four had a picture of upper GI obstruction and their imaging confirmed SMA-induced effect. The fifth had severe reflux esophagitis with recurrent vomiting and weight loss. Results Four patients were managed by Laparoscopic Duodenoejunostomy (DJ) to bypass and relieve the mechanical obstruction. The fifth patient had her hiatus hernia repaired whilst the SMA effect was managed expectantly. At the early post-operative phase , 2 patients had gastric paresis which resolved conservatively. On follow up ranging between 6 months to 18 months, all patients showed good recovery of their symptoms. Conclusions Diagnosis requires high index of suspicion. Once conservative measures are noted to be futile, there is no need to delay the definitive (surgical) management. Lap DJ is feasible and reproducible. Alternatively surgical management of the original (non SMA) cause of the weight loss may resolve the obstruction indirectly (e.g fundoplication for reflux) .Patients may need long term follow up to identify and treat recalcitrant problems ( e.g Gastroparesis and dysmotility)