Laparoscopic treatment of median arcuate ligament syndrome: a systematic review

Norberto, Enrique M. San; Romero, Alejandro; Domingos, Liliana Fidalgo; García-Sáiz, Irene; Taylor, James P.; Vaquero, Carlos

doi:10.23736/s0392-9590.19.04161-0

Cited by 19 publications

(22 citation statements)

References 74 publications

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“…29 We should therefore be mindful of the potential risk of recurrence after surgical release alone (24-47%). 30 We recommend post-operative CTA for moderate to high risk CMI patients and those with incomplete symptom relief post MAL release. Endovascular options should be discussed early with vascular surgeons to prioritize and plan for vascular reconstruction such as PTA of the coeliac artery.…”

Section: Discussionmentioning

confidence: 98%

A diagnostic workup and laparoscopic approach for median arcuate ligament syndrome

Diab

Berney

2022

ANZ Journal of Surgery

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Background: Median arcuate ligament syndrome (MALS) is a rare disorder characterized by the compression of the coeliac trunk and plexus by fibrous arches of the median ligament. It commonly occurs in young women with postprandial epigastric pain, weight loss and nausea. We present a single surgeon experience on the diagnostic approach and management of MALS with a focus on laparoscopic surgery. Methods: A retrospective review of adult patients diagnosed with MALS during a 10-year period (2011-2021) was conducted at Bankstown-Lidcombe hospital in New South Wales, Australia.Results: MALS was diagnosed in six patients (mean 46 years, range: 27-74 years old), all confirmed on mesenteric duplex ultrasound and computed tomography angiography. The most common presentations were women with post-prandial pain, exercise induced pain and an average weight loss of 14.5 kg. The median interval from onset of symptoms to surgical referral was 10.5 months. The average BMI was 24.1 kg/m 2 and most had a grade III American Society of Anaesthesiologist physical status. All patients underwent laparoscopic release of median arcuate ligament with one patient requiring endovascular stenting. The mean operative time was 119 minutes with two minor post-operative complications, but no mortalities. The median hospital length of stay was 3.5 days with a median follow up of 3.5 years. Conclusion: Laparoscopic median arcuate ligament release with endovascular support for selected cases provides sound clinical resolution of symptoms and long-term results.

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Section: Discussionmentioning

confidence: 98%

A diagnostic workup and laparoscopic approach for median arcuate ligament syndrome

Diab

Berney

2022

ANZ Journal of Surgery

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“…In a systematic review of 504 cases, patients undergoing laparoscopic treatment were found to have shorter hospital time and a shorter operative time than open surgical release. 12 As the abdominal pain and other symptoms are not related to ischemia, balloon angioplasty is not an option. Another approach is the use of endoscopic ultrasound to guide injection of the celiac plexus with steroids and/or lidocaine.…”

Section: Discussionmentioning

confidence: 99%

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

Ortega

Memon

Trivedi

et al. 2022

Journal of Investigative Medicine High Impact Case Reports

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Median arcuate ligament syndrome (MALS), also known as celiac artery compression syndrome, is a rare gastrointestinal condition with an estimated incidence of 2 per 100 000 population. Predominantly in female patients, this syndrome is characterized by the compression of the celiac artery at its origin from the aorta by the median arcuate ligament, which at the same time is entrapping the celiac plexus, causing upper abdominal pain, notably postprandial pain, as well as nausea, vomiting, food aversion, and weight loss. We present a case of abdominal pain secondary to MALS that was appropriately diagnosed after requiring narcotic medication, which responded to surgical therapy.

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“…Surgical treatment may be performed through laparotomy, laparoscopy or robotic-assisted laparoscopy. [ 13 ] Since the first release of the coeliac axis through laparoscopy by Roayaie et al . [ 14 ] in 2000, this access became the standard treatment of MALS.…”

Section: Discussionmentioning

confidence: 99%

Median arcuate ligament (Dunbar) syndrome

Kafadar

Oğuz

Aday

et al. 2021

Journal of Minimal Access Surgery

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Background: Median arcuate ligament syndrome (MALS) is a condition characterised by chronic abdominal symptoms associated with median arcuate ligament (MAL) compression of the coeliac artery. Aim: In this observational study, we aimed to evaluate the outcomes of laparoscopic treatment in patients with MALS. Materials and Methods: The data of ten patients with MALS who were subjected to laparoscopic sectioning of the MAL were retrospectively reviewed. The following data were evaluated: age, gender, clinical and diagnostic test findings, American Society of Anaesthesiologists score, operative findings and complications and mortality, hospital stay duration and hospital readmission. The diagnosis of MALS was established by computed tomography (CT) angiography. Results: Six (60%) of ten patients with MALS were female and four (40%) were male. The mean age was 42.4 ± 12.3. The main symptoms were epigastric pain (100%) and weight loss (60%). CT angiography showed high-grade stenosis of the anterior wall of the proximal coeliac trunk and post-stenotic dilation caused by extrinsic compression of the MAL. Surgical procedure was uneventful in all patients. Operating time was 155.5 min (120–200) and intra-operative blood loss was 150 ml (100–250). Length of stay was 3.1 day (2–9), with no mortality. The post-operative complications developed in two female patients. One of them developed ileus and the other patient developed pulmonary thromboembolism. At 6-month follow-up, all patients were asymptomatic. Conclusion: Laparoscopic decompression is an effective treatment for MALS and can provide symptomatic relief. This method may be the preferred modality of treatment in view of its lack of morbidity and good results.

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Laparoscopic treatment of median arcuate ligament syndrome: a systematic review

Cited by 19 publications

References 74 publications

A diagnostic workup and laparoscopic approach for median arcuate ligament syndrome

A diagnostic workup and laparoscopic approach for median arcuate ligament syndrome

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

Median arcuate ligament (Dunbar) syndrome

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