Laparoscopic Division of Median Arcuate Ligament for the Celiac Axis Compression Syndrome—Two Case Reports with Review of Literature

Abstract

Median arcuate ligament (MAL) syndrome is an uncommon condition caused by the external compression of the celiac trunk by the median arcuate ligament. In the current era of technological advancement, this syndrome may be corrected through the laparoscopic approach. We report two patients who were diagnosed as MAL syndrome and underwent laparoscopic division of MAL fibers at our institute. Both the patients improved symptomatically following the procedure and were discharged on the fourth post-operative day. Also, they remained symptom free during subsequent follow-up period of 1 year and 8 months, respectively. Laparoscopic approach to correct the MAL syndrome is feasible and safe. It may be the preferred modality of treatment in view of its superior visualization and lack of morbidity. However, adequate experience in advanced laparoscopic surgery is required before attempting this procedure.

Treatment of median arcuate ligament syndrome: outcome of laparoscopic approach

“…The treatment of MALS consists ofreleasingthe compression of the celiac axis by sectioning the median arcuate ligament 5,14 .…”

“…It may cause various clinicalsymptoms such as abdominal pain, weight loss, nausea and vomiting, and diarrhea. The pain isvariable and it may be mainly postprandial and alleviated by leaning the body forward [11][12][13][14] .In athletes, the pain may be exercise-induced rather than postprandial 7 . Epigastric bruit may be recognized during physical examination.…”

Intravascular ultrasound-guided laparoscopic division of the median arcuate ligament

“…This is traditionally achieved through surgical division of the median arcuate ligament by an open laparotomy. 1,3,13 Neurolysis and excision of the celiac plexus are also usually performed to address any neuropathic process. 7 After decompression, vascular reconstruction is often necessary because of structural changes in the vessel secondary to chronic compression leading to intimal hyperplasia and persistent stenosis.…”

Median arcuate ligament syndrome: case presentation and video‐illustrated laparoscopic management

“…An angiographic CT scan revealed celiac artery compression. The best treatment modality is release of the MAL fibers compressing the artery . We adopted the laparoscopic approach and successfully released the ligament fibers.…”