Laparoscopic management of median arcuate ligament syndrome
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Median arcuate ligament syndrome is a rare disorder resulting from luminal narrowing of the celiac artery by the insertion of the diaphragmatic muscle fibers or fibrous bands of the celiac nervous plexus [1, 3]. The syndrome is characterized by weight loss, postprandial abdominal pain, nausea, vomiting, and an epigastric bruit . Surgical management entails complete division of the median arcuate ligament . The video demonstrates the laparoscopic release of the median arcuate ligament in a patient with median arcuate ligament syndrome.
The patient is a 22-year-old male with a 6-month history of epigastric abdominal pain, nausea, vomiting, a 140-lb. weight loss, and an epigastric bruit on physical exam. Aortography demonstrated a ≥90% extrinsic compression of the celiac artery. A full laparoscopic skeletonization of the celiac artery and branch vessels was performed. Intraoperative duplex U/S demonstrated flow rate reduction after the median arcuate ligament release. A postoperative CT angiogram demonstrated no residual stenosis. The patient was discharged on postoperative day 3 and remained asymptomatic after 7 months of follow-up.
Laparoscopic release of the median arcuate ligament is a novel approach to the management of celiac artery compression syndrome . The role of minimally invasive techniques to manage median arcuate ligament syndrome is evolving but they appear to be a safe alternative to open surgery.
KeywordsMedian arcuate ligament Celiac artery compression Syndrome Stenosis Surgery Laparoscopy