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Observational Study
. 2020;33(1):e1495.
doi: 10.1590/0102-672020190001e1495. Epub 2020 May 18.

Treatment of median arcuate ligament syndrome: outcome of laparoscopic approach

[Article in Portuguese, English]
Julio Cezar Uili Coelho  1 , Andréa Virmond El Hosni  1 , Christiano MarloPaggi Claus  1 , Yan Sacha Hass Aguilera  1 , Gisele Pitrowsk Abot  1 , Alexandre Teixeira Coutinho de Freitas  1 , Marco Aurélio Raeder da Costa  1
Affiliations
Observational Study

Treatment of median arcuate ligament syndrome: outcome of laparoscopic approach

[Article in Portuguese, English]
Julio Cezar Uili Coelho et al. Arq Bras Cir Dig. 2020.

Abstract
in English, Portuguese, Portuguese

Background: Median arcuate ligament syndrome(MALS) is a rare condition thatmay cause significant clinical manifestations, including abdominal pain and weight loss. Its diagnosis may be difficult and very often delayed. The laparoscopic approach became the standard treatment of MALS.

Aim: To assess the outcome of laparoscopic treatment in patients with MALS.

Method: The data of sixpatients with MALS who were subjected to laparoscopic sectioning of the median arcuate ligament were retrospectively reviewed.The following data were evaluated: age, gender, clinical and diagnostic tests findings, ASA score, operative findings and complications, postoperative complications and mortality, hospital stay duration, and hospital readmission.The diagnosis of MALS was established by CT angiography and/or MR angiography.

Results: There were four (66.7%) women and two (33.3%) men aged from 32 to 60 years. The main symptoms were epigastric pain (100%) and weight loss (66.7%). The findings of high-grade stenosis of the proximal celiac axis and poststenotic dilation confirmed on angiography confirmed the diagnosis in all patients. Surgical procedure was uneventful in all patients. The only postoperative complication was urinary retention that occurred in a male. At three-month follow-up, all patients were asymptomatic.

Conclusion: Laparoscopic treatment of MALS is safe and effective in relieving the clinical manifestations of patients.

A síndrome do ligamento arqueado mediano (SLAM) é condição rara que pode causar manifestações clínicas significativas, incluindo dor abdominal e perda de peso. Seu diagnóstico pode ser difícil e muitas vezes estabelecido tardiamente. A abordagem laparoscópica tornou-se o tratamento padrão para ela.

Avaliar o resultado do tratamento laparoscópico em pacientes com SLAM.

Os dados de seis pacientes com SLAM submetidos a ressecção laparoscópica do ligamento arqueado mediano foram revisados ​​retrospectivamente. Os seguintes dados avaliados foram: idade, gênero, resultados dosexames clínicos e complementares, escore ASA, achados e complicações operatórias, complicações e mortalidade pós-operatórias, tempo de internação e readmissão hospitalar. O diagnóstico de SLAM foi estabelecido por angiotomografia e/ou angiorressonância.

Havia quatro (66,7%) mulheres e dois (33,3%) homens com idades entre 32 e 60 anos. Os principais sintomas foram dor epigástrica (100%) e perda de peso (66,7%). Os achados de estenose de alto grau do tronco celíaco proximal e dilatação pós-estenótica observados na angiografia confirmaram o diagnóstico em todos os pacientes. O procedimento cirúrgico transcorreu sem intercorrências em todos os pacientes. A única complicação pós-operatória foi retenção urinária, que ocorreu em um homem. No seguimento de três meses, todos os pacientes estavam assintomáticos.

O tratamento laparoscópico da SLAM é seguro e eficaz no alívio das manifestações clínicas dos pacientes.

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Conflict of interest statement

Conflict of interest: none

Figures

FIGURE 1
FIGURE 1. Laparoscopic treatment of median arcuate ligament syndrome: A)common hepatic artery (HA) and left gastric artery (GA) are isolated and dissected andthe celiac axis (CA) is exposed; B) section of the median arcuate ligament (MAL) with LigaSureMaryland jaw device is shown and exposure of the anterior wall of the aorta (A) is also depicted.
FIGURE 2
FIGURE 2. A) Computed tomographic angiography of the abdomen demonstrating severe stenosis of the proximal segment of the celiac axis (arrow) caused by extrinsic compression of the median arcuate on left side, and poststenotic dilation is also depicted with letter “d”;B) normal celiac axis (arrow) is shown after section of the median arcuate ligament on the right side.
See this image and copyright information in PMC

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