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. 2023 Apr 19:10:1169681.
doi: 10.3389/fsurg.2023.1169681. eCollection 2023.

Systematic hybrid laparoscopic and endovascular treatment of median arcuate ligament syndrome: A single-center experience

Michael Schneider  1 , Justine Longchamp  2 , Emilie Uldry  1 , Jean-Marc Corpataux  2 , Amaniel Kefleyesus  1 , Nermin Halkic  1
Affiliations

Systematic hybrid laparoscopic and endovascular treatment of median arcuate ligament syndrome: A single-center experience

Michael Schneider et al. Front Surg. .

Abstract

Background: Median arcuate ligament syndrome (MALS) is caused by celiac trunk (CT) compression by the median arcuate ligament. Clinically, this pathology varies from postprandial pain (Dunbar syndrome) to a life-threatening hemorrhage because of a rupture of a gastroduodenal artery aneurysm (GAA). Due to the low prevalence of this disease, there is no standard management for MALS.

Material and method: This was a single-center, retrospective study of 13 patients. Two groups were identified on the basis of the initial clinical presentation: those operated for a GAA rupture (bleeding group-BG) and those operated electively for Dunbar syndrome (Dunbar syndrome group-DG). The primary endpoint was 30-day postoperative complications of a systematic laparoscopic release of the median arcuate ligament and stenting during the same procedure.

Results: Seven patients (54%) underwent elective surgery. Six patients (46%) underwent semiurgent repair under elective conditions post-embolization for GAA bleeding. The total operative time was longer in the BG (p = 0.06). Two patients in the BG suffered early major complications and needed reintervention, and those in the DG had a lower comprehensive complication index. No mortality was reported at 30 days. Overall median length of stay was 5 days (IQR: 3.5-15.3). Patients in the DG had a significantly shorter length of stay (p = 0.02). At 6 months, the primary and secondary CT stent patencies were 82% and 100%, respectively. There were no high-flow GAA recurrences.

Conclusions: A combined approach of laparoscopic release of the median arcuate ligament and stenting during the same procedure is feasible and safe, and this approach must be systematically discussed in symptomatic patients.

Keywords: Dunbar syndrome; celiac trunk compression; endovascular treatment; laparoscopic surgery; median arcuate ligament syndrome; minimally invasive surgery.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
(A) Preoperative 3D computed tomography with the CT stenosis (red triangle) and the patent SMA (blue diamond). (B) Perioperative CT arteriography after stenting (red diamond). (C) Postoperative 3D computed tomography with the patent CT stents (blue triangle) and SMA (blue diamond). CT, celiac trunk; SMA, superior mesenteric artery.
See this image and copyright information in PMC

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