Celiac Axis Compression Syndrome: The Optimal Approach is Laparoscopic

INTRODUCTION: The objective of this study is to evaluate outcomes with laparoscopic management of celiac axis compression syndrome (CACS). Celiac axis compression syndrome (CACS) is a rare entity associated with epigastric abdominal pain and extrinsic compression of the celiac artery. Although the precise etiology is not certain, many patients benefit from open surgical decompression. Laparoscopic treatment has been uncommonly reported. We present 3 cases of laparoscopic treatment of CACS.

METHODS: We performed a retrospective review of 3 patients with CACS who underwent laparoscopic division of the arcuate ligament and celiac neural plexus. All patients had undergone extensive evaluation to rule out other etiologies for their epigastric pain. All patients had celiac artery stenosis by computed tomography angiography or conventional angiography. Two patients had undergone celiac artery stent placement prior to our evaluation. One had multiple celiac plexus blocks without resolution of symptoms.

RESULTS: All patients underwent successful laparoscopic division of the arcuate ligament and celiac neural plexus. Mean operative time was 131 min (range, 79 – 196). Length of stay was 1 day for all patients. There were no conversions to an open procedure and no complications. All patients reported significant resolution or improvement in their pain subjectively. At mean follow-up of 6 months (range, 2-8), all patients remained asymptomatic.

CONCLUSIONS: Laparoscopic decompression provides an effective, minimally invasive technique for decompressing the celiac axis and should be considered primary therapy over open surgery. Stenting should be reserved for intrinsic arterial pathology. We report the first small series of successful laparoscopic division of the arcuate ligament and celiac plexus in patients with CACS.


Session: Poster

Program Number: P361

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