Laparoscopic coeliac axis decompression for Dunbar syndrome: a step-by-step technical note
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Published on: June 17, 2018
Alessia Dessì1, Mauro Podda1, Raimondo Sanna1
1Department of Surgical Science, University of Cagliari, Cagliari, Italy.
Background:
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.
Methods:
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.
Results:
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.
Conclusions:
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.
