Laparoscopic Treatment of Medial Arcuate Ligament Syndrome

Clayton C Petro, MD, Michael J Rosen, MD, Yuri W Novitsky, MD. University Hospitals Case Medical Center.

Introduction:   A 48-year-old otherwise healthy female presented with “years” of worsening post-prandial abdominal pain associated with a gradual 45-lb weight loss. Her initial evaluation included an upper endoscopy that showed no obvious etiology of her symptoms. CTA showed isolated narrowing of the celiac trunk with no other stigmata of peripheral arterial disease.

Methods:   The patient was taken to the operating room with the plan for laparoscopic management by release of the median arcuate ligament and associated fibromuscular tissue causing external compression of the celiac vessels. Key steps included dissection of the left gastric artery, identification and dissection the celiac trunk as well as meticulous division of lymphoid and fibromuscular tissue around the celiac trunk.

Results:   The patient had no postoperative complications and was entirely relieved of her symptoms with 5-year follow-up.

Conclusion:   Laparoscopic management of this uncommon disease of exclusion is safe and effective. Importantly, a laparoscopic approach allows for excellent precision during this “high stakes” dissection in the absence of proximal/distal control.

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