Abstract
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.
Similar content being viewed by others
References
HH Lindner E Kemprud (1971) ArticleTitleA clinicoanatomical study of the arcuate ligament of the diaphragm Arch Surg 103 600–605 Occurrence Handle1:STN:280:CS2D3szktlE%3D Occurrence Handle5117015
S Roayaie G Jossart D Gitlitz P Lamparello L Hollier M Gagner (2000) ArticleTitleLaparoscopic release of celiac artery compression syndrome facilitated by laparoscopic ultrasound scanning to confirm restoration of flow J Vasc Surg 32 814–817 Occurrence Handle1:STN:280:DC%2BD3M%2FjtFKqtQ%3D%3D Occurrence Handle11013046
MA Snyder EB Mahoney CG Rob (1967) ArticleTitleSymptomatic celiac artery stenosis due to constriction by the neurofibrous tissue of the celiac ganglion Surgery 61 372–376 Occurrence Handle1:STN:280:CCiC38jitFU%3D Occurrence Handle6021256
TJ Takach JJ Livesay GJ Reul DA Cooley (1996) ArticleTitleCeliac compression syndrome: tailored therapy based on intraoperative findings J Am Coll Surg 183 606–610 Occurrence Handle1:STN:280:ByiC3MnjslE%3D Occurrence Handle8957463
Author information
Authors and Affiliations
Corresponding author
Additional information
Rights and permissions
About this article
Cite this article
Carbonell, A.M., Kercher, K.W., Heniford, B.T. et al. Laparoscopic management of median arcuate ligament syndrome. Surg Endosc 19, 729 (2005). https://doi.org/10.1007/s00464-004-6010-x
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/s00464-004-6010-x