Treatment outcomes in patients with median arcuate ligament syndrome

Abstract

Aim. This article aims to present the author’s experience with laparoscopic decompression of the celiac trunk in a patient diagnosed with celiac trunk compression syndrome (Dunbar syndrome).Methods. This article presents a retrospective analysis of the treatment outcomes in eight patients who underwent surgery between January 2020 and December 2023. The diagnosis was established on the basis of complaints, CT angiography and ultrasound. In all patients, the steps of surgical intervention included access to the abdominal cavity, survey laparoscopy and placement of trocars. Afterwards, the lesser omentum was opened to gain access to the base of the legs of the esophageal opening of the diaphragm. Next, the arcuate ligament was isolated with subsequent intersection, as a result of which the contouring of the celiac trunk was determined.Results. The average operation time was 93.72 minutes, ranging between 60 and 180 minutes; the average blood loss was 36.25 ml. The average hospital stay was 3.25 days. When assessing longterm results, five patients experienced complete recovery, three patients noted a decrease in the intensity and frequency of pain. After surgery, all patients underwent ultrasound scanning of the celiac trunk; expiratory blood flow velocity and PSV in the SN/PSV were within the reference range.Conclusion. The study found that in most patients with this disease, the clinical presentation is characterised by complaints of nausea, vomiting, weight loss, and pain after eating or physical activity, which aligns with data from the literature. In diagnosing the disease, the methods of computed angiography and ultrasound of the celiac trunk are of greatest clinical importance. The indication for surgical treatment of Dunbar syndrome is the presence of stenosis of the celiac trunk and symptoms of chronic abdominal ischemia. The study results indicate that laparoscopic decompression of the celiac trunk with dissection of the celiac plexus is a safe and effective treatment method.