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[Laparoscopic Division of the Arcuate Ligament: Treatment of the Coeliac Artery Compression Syndrome]
D B Ellebrecht1, C F M Jung1, M Hoffmann1
1Klinik für Chirurgie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Deutschland.
Insights
Coeliac artery compression syndrome, caused by arcuate ligament pressure, leads to pain and weight loss. Laparoscopic division of the ligament offers a minimally invasive treatment, improving patient quality of life.
Area of Science:
- Gastroenterology
- Vascular Surgery
- Minimally Invasive Surgery
Background:
- Coeliac artery compression syndrome (CACS) is caused by the arcuate ligament compressing the coeliac artery and plexus.
- Symptoms include postprandial pain, weight loss, and sometimes an epigastric bruit, significantly impacting quality of life.
Observation:
- The syndrome is diagnosed based on a characteristic symptom triad and radiological confirmation (duplex sonography, CTA, MRA).
Findings:
- Laparoscopic division of the arcuate ligament is a successful treatment for CACS.
- This minimally invasive approach involves dividing the arcuate ligament above the coeliac artery origin.
Implications:
- Laparoscopic decompression effectively treats CACS, alleviating symptoms and restoring patients' quality of life.
- Resection of the coeliac plexus can be performed concurrently.
- This procedure is largely uneventful and offers a significant improvement over traditional treatments.
Abstract:
Objective: The coeliac artery compression syndrome, first described by Harjola und Dunbar, results from the coeliac artery and plexus being compressed by the arcuate ligament at their origin. The clinical symptoms are postprandial pain and weight loss and the syndrome significantly restricts patients' quality of life. In rare cases, an epigastric bruit is detected on clinical examination. Laparoscopic division of the arcuate ligament is a successful option for the treatment of the coeliac artery compression syndrome. Indications: Laparoscopic decompression is indicated for patients with a symptom triad of postprandial pain, weight loss and epigastric bruit and radiologic confirmation of coeliac artery compression by duplex sonography, computed tomography angiography or magnetic resonance angiography. Procedure: The operative strategy is based on the division of the arcuate ligament following its visualisation above the origin of the coeliac artery from the abdominal aorta. Conclusion: The laparoscopic division of the arcuate ligament and the resection of the coeliac plexus are a largely uneventful, minimally-invasive option to treat the coeliac artery compression syndrome and restore patients' quality of life.
