Chronic Non-specific Upper Abdominal Pain of Median Arcuate Ligament Syndrome: Laparoscopic Treatment

Abstract

Median arcuate ligament syndrome (MALS) is caused by extrinsic compression of the celiac artery. It is characterized clinically by postprandial abdominal pain, nausea, vomiting, and weight loss, mimicking chronic mesenteric ischemia. Patients often undergo exhaustive but unremarkable diagnostic workup. Diagnosis is based on a combination of Doppler or angiographic studies of the celiac artery and clinical presentation. We report our 11-year experience (2008–19) of laparoscopic treatment of MALS. The objectives of this study were to review our technical experience and describe the long-term surgical outcomes. Out of 17 patients treated for MALS, 14 were female and with a median age of 36 years. All of them presented with abdominal pain. The length of symptoms on presentation was 10 months. Duplex ultrasonography indicated celiac trunk stenosis in each case, with an elevated peak velocity flow in the celiac trunk of 431 (± 80) cm/s. All underwent successful laparoscopic treatment with only one conversion to open. The operating time was 117 min (70–122) and intraoperative blood loss was < 50 ml in all but one converted to open. Length of stay was 3 to 6 days, with no postoperative complications or mortality. Median follow-up was 109.5 months (78–113.5). At this point, all patients remained symptom-free with only one patient who complained of occasional pain, not requiring any analgesics. Laparoscopic management of MALS is a safe and effective approach to achieve long-term improvement of symptoms after surgery.