Treatment of median arcuate ligament syndrome: outcome of laparoscopic approach.

Julio Cezar Uili Coelho,Marco Aurélio Raeder Da Costa,Yan Sacha Hass Aguilera,Alexandre Teixeira Coutinho De Freitas,Andréa Virmond El Hosni,Christiano Marlopaggi Claus,Gisele Pitrowsk Abot

doi:10.1590/0102-672020190001e1495

Abstract

ABSTRACT Background:Median arcuate ligament syndrome(MALS) is a rare condition thatmay cause significant clinical manifestations, including abdominal pain and weight loss. Its diagnosis may be difficult and very often delayed. The laparoscopic approach became the standard treatment of MALS. Aim:To assess the outcome of laparoscopic treatment in patients with MALS. Method:The data of sixpatients with MALS who were subjected to laparoscopic sectioning of the median arcuate ligament were retrospectively reviewed.The following data were evaluated: age, gender, clinical and diagnostic tests findings, ASA score, operative findings and complications, postoperative complications and mortality, hospital stay duration, and hospital readmission.The diagnosis of MALS was established by CT angiography and/or MR angiography. Results:There were four (66.7%) women and two (33.3%) men aged from 32 to 60 years. The main symptoms were epigastric pain (100%) and weight loss (66.7%). The findings of high-grade stenosis of the proximal celiac axis and poststenotic dilation confirmed on angiography confirmed the diagnosis in all patients. Surgical procedure was uneventful in all patients. The only postoperative complication was urinary retention that occurred in a male. At three-month follow-up, all patients were asymptomatic. Conclusion:Laparoscopic treatment of MALS is safe and effective in relieving the clinical manifestations of patients.

Highlights

Median arcuate ligament syndrome(MALS) namedDunbar syndrome or celiac axis compression syndrome - is due to compression of the celiac axis and/or celiac ganglion by the median arcuate ligament of the diaphragm[1,3,15,20]
It was first described by Harjola[6] in 1963 who reported resolution of postprandial upper abdominal pain and epigastric bruit in a man following surgical decompression of the celiac axis due to a fibrous celiac ganglion.Dunbar et al[4] in 1965 reported a series of 15 patients with abdominal angina due to partial celiac artery compression by the median arcuate ligament
Clinical manifestations lasted from eight months to three years

Summary

Introduction

Median arcuate ligament syndrome(MALS) namedDunbar syndrome or celiac axis compression syndrome - is due to compression of the celiac axis and/or celiac ganglion by the median arcuate ligament of the diaphragm[1,3,15,20] It was first described by Harjola[6] in 1963 who reported resolution of postprandial upper abdominal pain and epigastric bruit in a man following surgical decompression of the celiac axis due to a fibrous celiac ganglion.Dunbar et al[4] in 1965 reported a series of 15 patients with abdominal angina due to partial celiac artery compression by the median arcuate ligament. Our objective was to evaluate the outcome of laparoscopic treatment of patients with MALS in our hospital

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Results

Conclusion