Laparoscopic management of median arcuate ligament syndrome

  • A. M. Carbonell
  • K. W. Kercher
  • B. T. Heniford
  • B. D. MatthewsEmail author
Multimedia article


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 [2]. Surgical management entails complete division of the median arcuate ligament [4]. 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 [2]. 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.


Median arcuate ligament Celiac artery compression Syndrome Stenosis Surgery Laparoscopy 


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    Snyder, MA, Mahoney, EB, Rob, CG 1967Symptomatic celiac artery stenosis due to constriction by the neurofibrous tissue of the celiac ganglionSurgery61372376PubMedGoogle Scholar
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    Takach, TJ, Livesay, JJ, Reul, GJ, Cooley, DA 1996Celiac compression syndrome: tailored therapy based on intraoperative findingsJ Am Coll Surg183606610PubMedGoogle Scholar

Copyright information

© Springer 2005

Authors and Affiliations

  • A. M. Carbonell
    • 1
  • K. W. Kercher
    • 1
  • B. T. Heniford
    • 1
  • B. D. Matthews
    • 2
    Email author
  1. 1.Carolinas Laparoscopic and Advanced Surgery Program, Department of General SurgeryCarolinas Medical CenterCharlotteUSA
  2. 2.Washington University, Department of SurgerySt. LouisUSA

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