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