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Laparoscopic median arcuate ligament release using an anterior approach for median arcuate ligament syndrome
Koji Kubota1, Akira Shimizu1, Tsuyoshi Notake1
1Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery Shinshu University School of Medicine Nagano Japan.
Abstract:
Median arcuate ligament syndrome (MALS) is a rare condition characterized by nonspecific symptoms, such as abdominal pain, nausea, and vomiting. Furthermore, the development and rupture of pancreaticoduodenal artery aneurysms pose a potentially fatal risk. Median arcuate ligament release (MALR) is useful in the treatment of MALS, with most procedures performed laparoscopically. However, detailed descriptions of laparoscopic MALR (lap-MALR) procedures are rare. In this study, we performed lap-MALR via an anterior approach with dissection of the right lateral wall of the celiac artery (CA). For optimal visualization of the right side of the CA, the right branch of the inferior phrenic artery was divided. We believe that this procedure allows the MAL to be released within a sufficient surgical field and without excess or deficiency. Here, we present the details of six patients who underwent lap-MALR for varying indications; three for pancreaticoduodenal artery aneurysms due to CA obstruction (unruptured, n = 1; ruptured, n = 2), two cases prior to hepato-biliary-pancreatic surgery, and one symptomatic case. In all cases, lap-MALR was performed as described above, and the CA stenosis was successfully released. Our case series demonstrates the safety and reliability of our lap-MALR procedure in the treatment of MALS-related disorders, including pancreaticoduodenal artery aneurysms associated with CA compression.
Insights
Median arcuate ligament release (MALR) via laparoscopy effectively treats MALS and related aneurysms. This anterior approach ensures safe and reliable celiac artery decompression for MALS patients.
Area of Science:
- Vascular Surgery
- Minimally Invasive Procedures
- Gastroenterology
Background:
- Median arcuate ligament syndrome (MALS) presents with vague abdominal symptoms and carries a risk of life-threatening pancreaticoduodenal artery aneurysms.
- Laparoscopic median arcuate ligament release (lap-MALR) is a treatment option, but detailed procedural descriptions are scarce.
- Celiac artery (CA) compression is a key factor in MALS and associated aneurysms.
Purpose of the Study:
- To describe a detailed anterior approach for laparoscopic median arcuate ligament release (lap-MALR).
- To evaluate the safety and efficacy of this lap-MALR technique in patients with MALS-related conditions.
- To present outcomes for patients undergoing lap-MALR for pancreaticoduodenal artery aneurysms and other indications.
Main Methods:
- Performed lap-MALR using an anterior approach with dissection of the right lateral wall of the celiac artery (CA).
- Divided the right branch of the inferior phrenic artery for enhanced visualization of the CA.
- Applied the technique to six patients with MALS-related disorders, including aneurysms and pre-surgical cases.
Main Results:
- Successful release of CA stenosis was achieved in all six patients.
- The described lap-MALR technique provided adequate surgical visualization and safe ligament release.
- The procedure was applied to diverse indications, including ruptured and unruptured aneurysms.
Conclusions:
- The presented anterior lap-MALR approach is safe and reliable for treating MALS and associated pancreaticoduodenal artery aneurysms.
- This technique facilitates effective decompression of the celiac artery in a well-visualized surgical field.
- Laparoscopic MALR is a viable option for managing complex MALS-related vascular complications.
