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

Median arcuate ligament syndrome is a rare cause of chronic postprandial abdominal pain due to extrinsic compression of the coeliac trunk. Surgical decompression remains the mainstay of treatment.

We report a step-by-step technical note of laparoscopic coeliac axis decompression in a 31-year-old woman with long-standing postprandial abdominal pain, nausea, and vomiting. Preoperative CT angiography demonstrated focal stenosis of the coeliac trunk, confirmed by colour duplex ultrasonography. This technical note provides a reproducible description of the laparoscopic approach, focusing on anatomical exposure, vascular landmarks, safe dissection along the anterior aortic plane, and complete coeliac axis release.

Operative time was 90 min. The postoperative course was uneventful. The patient reported complete symptom resolution and tolerated a solid diet from the second postoperative day. She was discharged home on postoperative day four. Two-week CT angiography showed restoration of coeliac trunk calibre, with no residual stenosis or extrinsic compression. Duplex ultrasonography at two months demonstrated no abnormalities in peak systolic velocity.

Laparoscopic coeliac axis decompression is a safe and feasible option in patients with Dunbar syndrome. Magnified exposure may facilitate safe dissection and complete release. Clinical follow-up should combine objective vascular imaging with assessment of functional outcomes and quality of life.