Laparoscopic treatment of rare median arcuate ligament syndrome – medium-term follow-up

The paper "Laparoscopic treatment of the rare median arcuate ligament syndrome - mid-term follow-up" is important because the results of treatment are based not only on the subjective feelings of patients, but also on objective imaging tests, which is not observed in the previously published works on this topic. SUMMARY Introduction Median arcuate ligament syndrome [MALS] is a rare cause of chronic epigastric pain. The presentation might be unclear and non-specific. Diagnosing the syndrome requires interdisciplinary methods and specialists. Treatments consist of celiac axis release performed laparoscopically or robotically, and intraluminal stenting. The aim of the study was to report the medium-term postoperative follow-up results for four patients with MALS. Material and methods We performed 5 laparoscopic celiac axis releases in patients with MALS in our department in 2018. We included 4 patients in this study and all patients were admitted 16-23 months after the surgery for computed tomography angiography. Results Patients constituted 4 women aged 28-63 years with a mean body mass index of 22.4 kg/m2. The diagnosis of MALS was confirmed by computed tomography angiography, which showed severe (> 70%) narrowing of the celiac axis. Patients underwent laparoscopic celiac axis release, and all patients were discharged on the first postoperative day with no postoperative complications. Patients improved quality of life and complete relief of symptoms. Follow-up computed tomography angiography confirmed full decompression of the celiac axis in all four patients, with no stenosis caused by scarification of the celiac axis. Conclusions Laparoscopy is a valuable and safe method to treat patients with MALS. Keywords: Dunbar syndrome, median arcuate ligament syndrome, laparoscopy, MALS, digestive surgery

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Median Arcuate Ligament Syndrome: A Case Report

Journal of Society of Surgeons of Nepal ◽

10.3126/jssn.v21i2.24360 ◽

2018 ◽

Vol 21 (2) ◽

pp. 38-39

Author(s):

Akash Chitrakar ◽

Nirajan Subedi ◽

Ramesh Singh Bhandari

Keyword(s):

Computed Tomography ◽

Case Report ◽

Epigastric Pain ◽

Celiac Artery ◽

Celiac Axis ◽

Median Arcuate Ligament ◽

Median Arcuate Ligament Syndrome ◽

Celiac Ganglion ◽

Extrinsic Compression ◽

Arcuate Ligament

Median arcuate ligament (MAL) syndrome results from extrinsic compression of the celiac axis and or celiac ganglion by the MAL and diaphragmatic crura. A seventy five years lady presented with post prandial epigastric pain for 6 months. She had undergone considerable investigations for other diagnoses before an abdominal computed tomography (CT) revealed median arcuate ligament impinging celiac artery at its origin. She successfully underwent laparotomy and release of median arcuate ligament.

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Prevalence of signs of celiac axis compression by the median arcuate ligament on computed tomography angiography in asymptomatic patients

Journal of Vascular Surgery ◽

10.1016/j.jvs.2018.04.044 ◽

2018 ◽

Vol 68 (6) ◽

pp. 1782-1787 ◽

Cited By ~ 7

Author(s):

Alexandre Petnys ◽

Pedro Puech-Leão ◽

Antonio Eduardo Zerati ◽

Raphael Mendes Ritti-Dias ◽

William Carlos Nahas ◽

...

Keyword(s):

Computed Tomography ◽

Computed Tomography Angiography ◽

Celiac Axis ◽

Median Arcuate Ligament ◽

Asymptomatic Patients ◽

Axis Compression ◽

Arcuate Ligament

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Laparoscopic treatment for celiac artery stenosis caused by median arcuate ligament compression with Adachi V type vascular anomaly: a case report

Surgical Case Reports ◽

10.1186/s40792-021-01226-3 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Hiroshi Saito ◽

Koichiro Sawada ◽

Jyunichi Ogawa ◽

Masashi Hashimoto ◽

Masahiro Oshima ◽

...

Keyword(s):

Epigastric Pain ◽

Vascular Anomaly ◽

Celiac Artery ◽

Artery Stenosis ◽

Laparoscopic Treatment ◽

Median Arcuate Ligament ◽

Case Presentation ◽

Arcuate Ligament ◽

Major Vascular Injury

Abstract Background Median arcuate ligament syndrome (MALS), which results from compression of the median arcuate ligament (MAL), is a rare cause of abdominal pain and weight loss. Treatment is dissection of the MAL; however, the laparoscopic procedure is not yet established and it involves the risk of major vascular injury, especially in cases with an anomaly. Case presentation A 47-year-old man was evaluated at the hospital for epigastric pain. Contrast computed tomography scan revealed stenosis of the celiac artery origin due to the MAL. An Adachi V type vascular anomaly was also observed. Laparoscopic treatment was performed to release pressure on the celiac artery. Laparoscopic ultrasonography was used to less invasively confirm the release of the MAL. Despite a concomitant Adachi V type vascular anomaly, surgery was safely performed using the laparoscopic magnification view and intraoperative ultrasonography. Follow-up ultrasonography confirmed the celiac artery stenosis has not recurred. Conclusions A rare case of MALS with an Adachi V type vascular anomaly is presented and the laparoscopic treatment is detailed.

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Laparoscopic treatment of median arcuate ligament syndrome in a 16-year-old male

International Journal of Surgery Case Reports ◽

10.1016/j.ijscr.2018.10.006 ◽

2018 ◽

Vol 52 ◽

pp. 79-83 ◽

Cited By ~ 1

Author(s):

Yoshinori Fujiwara ◽

Masaharu Higashida ◽

Hisako Kubota ◽

Yusakua Watanabe ◽

Michi Ueno ◽

...

Keyword(s):

Laparoscopic Treatment ◽

Median Arcuate Ligament ◽

Median Arcuate Ligament Syndrome ◽

Arcuate Ligament

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Laparoscopic treatment of median arcuate ligament syndrome

Intractable & Rare Diseases Research ◽

10.5582/irdr.2019.01031 ◽

2019 ◽

Vol 8 (2) ◽

pp. 108-112 ◽

Cited By ~ 4

Author(s):

Zhipeng Sun ◽

Dongdong Zhang ◽

Guangzhong Xu ◽

Nengwei Zhang

Keyword(s):

Laparoscopic Treatment ◽

Median Arcuate Ligament ◽

Median Arcuate Ligament Syndrome ◽

Arcuate Ligament

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Celiac axis compression by median arcuate ligament on computed tomography among asymptomatic persons

Indian Journal of Gastroenterology ◽

10.1007/s12664-010-0028-x ◽

2010 ◽

Vol 29 (3) ◽

pp. 121-123 ◽

Cited By ~ 14

Author(s):

Seethu Soman ◽

Sniya Valsa Sudhakar ◽

Shyamkumar Nidugala Keshava

Keyword(s):

Computed Tomography ◽

Celiac Axis ◽

Median Arcuate Ligament ◽

Axis Compression ◽

Arcuate Ligament

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Treatment of median arcuate ligament syndrome: outcome of laparoscopic approach

ABCD Arquivos Brasileiros de Cirurgia Digestiva (São Paulo) ◽

10.1590/0102-672020190001e1495 ◽

2020 ◽

Vol 33 (1) ◽

Cited By ~ 1

Author(s):

Julio Cezar Uili COELHO ◽

Andréa Virmond El HOSNI ◽

Christiano MarloPaggi CLAUS ◽

Yan Sacha Hass AGUILERA ◽

Gisele Pitrowsk ABOT ◽

...

Keyword(s):

Weight Loss ◽

Epigastric Pain ◽

Clinical Manifestations ◽

Laparoscopic Approach ◽

Rare Condition ◽

Laparoscopic Treatment ◽

Median Arcuate Ligament ◽

Median Arcuate Ligament Syndrome ◽

Arcuate Ligament ◽

Operative Findings

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.

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