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. 2024 Jul 1;20(3):359-362.
doi: 10.4103/jmas.jmas_253_23. Epub 2024 Jan 9.

Laparoscopic repair of iatrogenic celiac artery injury during median arcuate ligament release: A retrospection and tips at troubleshooting

Ganesh Shenoy  1 , Marina Thomas, B S Ramesh
Affiliations

Laparoscopic repair of iatrogenic celiac artery injury during median arcuate ligament release: A retrospection and tips at troubleshooting

Ganesh Shenoy et al. J Minim Access Surg. .

Abstract

Median arcuate ligament (MAL) syndrome or celiac artery (CA) compression syndrome previously treated mainly by vascular surgeons using the open approach is now being increasingly performed by general surgeons with training in advanced laparoscopy. Although this approach has all the advantages of minimal access surgery, the procedure is fraught with serious complications like injury to major vascular structures during dissection. Vascular injury by far is the major cause of conversion to open procedure. Herein, we report a laparoscopic repair of iatrogenic CA injury by intra-corporeal suturing during MAL release. We also elaborate the causes, the preventive measures that can be applied to avoid such catastrophic occurrences in future. To the best of our knowledge, this is the first report of a laparoscopic repair of CA bleed during MAL release.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
(a) Contrast-enhanced computed tomography scan showing severe focal stenosis of celiac artery (white arrow), post-stenotic dilatation (blue arrow) and hooked shaped configuration of celiac trunk (red arrow), (b) Ports (blue arrow: Camera port, liver retraction), (c) Branches of celiac artery cleared of fibrofatty tissue (blue arrow: Fibrofatty tissue, red arrow: Left gastric artery), (d and e) Dissection and division of thickened median arcuate ligament (MAL) fibres with harmonic shears (white arrow: Aorta, black arrow: Crural angle), (f) Division of deepest MAL fibres over celiac artery near crural angle (black arrow: deepest MAL fibers)
Figure 2
Figure 2
(a) Bleed from celiac artery (white arrow), (b) Rent on celiac artery immediately grasped. Suction done for clear vision, (c-e) Repair of celiac artery rent using 4-0 polypropylene sutures, (f-h) Repair of celiac artery with second figure of eight sutures (white arrow: suture repaired celiac artery)
Figure 3
Figure 3
(a and b) Completed closure of rent over celiac artery (white arrow: Repaired celiac artery, red arrow: Looped left gastric artery), (c) Origin of celiac artery (white arrow), (d and e) Crural closure with 2-0 polyester, (f) Completed median arcuate ligament release, celiac artery repair and crural closure (white arrow: Gap left between celiac artery origin and the crural closure)
See this image and copyright information in PMC

References

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