Laparoscopic coeliac axis decompression for Dunbar syndrome: a step-by-step technical note

Area of Science:

• Minimally Invasive Surgery
• Gastroenterology
• Vascular Surgery

Background:

• Median arcuate ligament syndrome (MALS) is a rare condition causing chronic postprandial abdominal pain.
• It results from extrinsic compression of the coeliac trunk, impacting blood flow to abdominal organs.
• Surgical decompression is the primary treatment for MALS.

Purpose of the Study:

• To present a step-by-step technical note on performing laparoscopic coeliac axis decompression.
• To detail a reproducible approach for this minimally invasive procedure.
• To evaluate the safety and efficacy of this surgical technique.

Main Methods:

• Laparoscopic coeliac axis decompression was performed on a 31-year-old woman with MALS.
• Preoperative imaging included CT angiography and duplex ultrasonography to confirm coeliac trunk stenosis.
• The technique focused on precise anatomical exposure, landmark identification, and safe dissection.

Main Results:

• The laparoscopic procedure took 90 minutes with an uneventful postoperative recovery.
• The patient experienced complete symptom resolution, tolerating a solid diet by postoperative day two.
• Postoperative imaging confirmed restored coeliac trunk calibre and no residual compression.

Conclusions:

• Laparoscopic coeliac axis decompression is a safe and feasible treatment for Dunbar syndrome (MALS).
• Magnified laparoscopic visualization aids in safe dissection and complete release of the coeliac axis.
• Long-term follow-up should integrate vascular imaging with functional outcome and quality of life assessments.