Treatment of median arcuate ligament syndrome: outcome of laparoscopic approach

Abstract

Background: Median arcuate ligament syndrome(MALS) is a rare condition thatmay cause significant clinical manifestations, including abdominal pain and weight loss. Its diagnosis may be difficult and very often delayed. The laparoscopic approach became the standard treatment of MALS. Aim: To assess the outcome of laparoscopic treatment in patients with MALS. Method: The data of sixpatients with MALS who were subjected to laparoscopic sectioning of the median arcuate ligament were retrospectively reviewed.The following data were evaluated: age, gender, clinical and diagnostic tests findings, ASA score, operative findings and complications, postoperative complications and mortality, hospital stay duration, and hospital readmission.The diagnosis of MALS was established by CT angiography and/or MR angiography. Results: There were four (66.7%) women and two (33.3%) men aged from 32 to 60 years. The main symptoms were epigastric pain (100%) and weight loss (66.7%). The findings of high-grade stenosis of the proximal celiac axis and poststenotic dilation confirmed on angiography confirmed the diagnosis in all patients. Surgical procedure was uneventful in all patients. The only postoperative complication was urinary retention that occurred in a male. At three-month follow-up, all patients were asymptomatic. Conclusion: Laparoscopic treatment of MALS is safe and effective in relieving the clinical manifestations of patients.

Another Sherlock Holmes Mystery: Abdominal Pain Explained by Median Arcuate Ligament Syndrome

“…Epigastric pain has been the most reported symptom in 100% of patients, weight loss in 48% to 67% of patients, and nausea and diarrhea in approximately 8% to 10% of patients. 8 - 10 …”

Median arcuate ligament (Dunbar) syndrome: Laparoscopic management and clinical outcomes of a single centre

“…There have been reported some other case reports and several small series of patients who underwent laparoscopic division of the MAL. [ 25 26 27 ] In the largest of these, Tulloch et al . [ 28 ] published a retrospective review of outcomes in patients with the MALS and compared laparoscopic versus open coeliac ganglionectomy over a 10-year period.…”

Celiac Artery Compression Syndrome: A Unique Presentation

“…Treatment is achieved primarily through surgical decompression of the celiac trunk via open, laparoscopic or robot-assisted division of the median arcuate ligament, with select patients requiring intravascular procedures to relieve stenosis of the celiac artery [ 2 , 3 , 8 ]. Patients who undergo surgical decompression often experience marked and lasting symptomatic relief [ 1 , 4 , 8 ].…”

“…The diagnosis can be made with a combination of imaging modalities including mesenteric vascular duplex, computed tomography angiography, and less commonly celiac artery angiography with respiratory maneuvers [1,2,[5][6][7]. Treatment is achieved primarily through surgical decompression of the celiac trunk via open, laparoscopic or robot-assisted division of the median arcuate ligament, with select patients requiring intravascular procedures to relieve stenosis of the celiac artery [2,3,8]. The following is a case that depicts an interesting presentation of a 44-year-old male diagnosed with this rare condition.…”