Journal of Gastrointestinal Surgery

, Volume 22, Issue 4, pp 713–721 | Cite as

Laparoscopic Treatment of Median Arcuate Ligament Syndrome: Analysis of Long-Term Outcomes and Predictive Factors

  • Javier A. Cienfuegos
  • Mateo G. Estevez
  • Miguel Ruiz-Canela
  • Fernando Pardo
  • Alberto Diez-Caballero
  • Isabel Vivas
  • Jose Ignacio Bilbao
  • Pablo Martí-Cruchaga
  • Gabriel Zozaya
  • Víctor Valentí
  • José Luis Hernández-Lizoáin
  • Fernando Rotellar
Original Article
  • 165 Downloads

Abstract

Background

Laparoscopic arcuate ligament release has been demonstrated a valid therapeutic option for arcuate ligament syndrome. Nevertheless, long-term follow-up and predictive factors have not been described for this treatment.

Methods

Clinical and surgical data and short- and long-term outcomes together with the impact of the degree of stenosis of the celiac trunk were analyzed in 13 consecutive patients who underwent laparoscopic arcuate ligament release between 2001 and 2013.

Results

Thirteen patients (12 F/1 M) underwent surgery. The median age was 32 years old, and their mean body mass index was 20.7 (range 14.7–25). The 13 patients presented with intense postprandial abdominal pain. Ten cases were associated with weight loss. The median duration of symptoms was 24 months (range 2–240). Three patients presented symptoms associated with superior mesenteric artery syndrome. Median operative time was 120 min (range 90–240), and there were no conversions to open surgery. Median hospital stay was 3 days (range 2–14). Over a median follow-up of 117 months (range 45–185), nine patients had excellent results although two required endovascular procedures at 70 and 24 months after surgery. Four patients (30.7%) experienced poor outcomes. When we analyzed the impact of the degree of occlusion of the celiac trunk, we observed that in patients with severe occlusion (> 70%), better results were obtained, with complete resolution of symptoms in 71% of cases.

Conclusion

Laparoscopic arcuate ligament release constitutes an excellent treatment for arcuate ligament syndrome. The degree of occlusion of the celiac trunk may be a factor predictive of long-term outcomes.

Keywords

Median arcuate ligament syndrome Laparoscopic surgery Celiac trunk Celiac artery compression syndrome Outcomes 

Abbreviations

LALR

laparoscopic arcuate ligament release

ALS

arcuate ligament syndrome

CT

celiac trunk

CTA

computed tomography angiography

BMI

body-mass-index

ASA

American Society of Anesthesiologist Score

AL

arcuate ligament

SMAS

superior mesenteric artery syndrome

Notes

Acknowledgements

The authors are grateful to Paul Miller Ph.D. for the language editing and Lydia Munárriz for transcribing the manuscript. We also want to thank Maria Molina, RN for data managing.

Author Contributions

The following criteria define each of the author’s contributions to the study and manuscript:

1. Contributed to the conception and design of the study

2. Contributed to acquisition of data

3. Contributed to analysis and interpretation of data

4. Participated in drafting of the paper

5. Participated in revising the paper critically for important intellectual content.

6. Gave final approval of the version to be published and agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Javier A. Cienfuegos and Fernando Rotellar: 1, 2, 3, 4, 5, 6

Mateo G. Estevez and Miguel Ruiz-Canela: 2, 3, 5, 6

Fernando Pardo, Alberto Diez-Caballero: 1, 5, 6

Isabel Vivas, Jose Ignacio Bilbao, Pablo Martí-Cruchaga, Gabriel Zozaya, Víctor Valentí, José Luis Hernández-Lizoáin: 2, 5, 6

Compliance with Ethical Standards

The study was approved by the ethics committee of the center.

Conflict of Interest

The authors declare that they have no conflicts of interest.

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Copyright information

© The Society for Surgery of the Alimentary Tract 2017

Authors and Affiliations

  • Javier A. Cienfuegos
    • 1
    • 2
  • Mateo G. Estevez
    • 1
    • 2
  • Miguel Ruiz-Canela
    • 2
    • 3
  • Fernando Pardo
    • 1
    • 2
  • Alberto Diez-Caballero
    • 4
  • Isabel Vivas
    • 2
    • 5
  • Jose Ignacio Bilbao
    • 2
    • 5
  • Pablo Martí-Cruchaga
    • 1
    • 2
  • Gabriel Zozaya
    • 1
    • 2
  • Víctor Valentí
    • 1
    • 2
  • José Luis Hernández-Lizoáin
    • 1
    • 2
  • Fernando Rotellar
    • 1
    • 2
  1. 1.Department of General Surgery, Clínica Universidad de Navarra, School of MedicineUniversity of NavarraPamplonaSpain
  2. 2.Instituto de Investigación Sanitaria de Navarra (IdisNA)PamplonaSpain
  3. 3.Department of Preventive Medicine and Public Health, School of MedicineUniversity of NavarraPamplonaSpain
  4. 4.Quirúrgica Cirujanos AsociadosCentro Médico TeknonBarcelonaSpain
  5. 5.Department of Radiology, Clínica Universidad de Navarra, School of MedicineUniversity of NavarraPamplonaSpain

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