Experience with Laparoscopic Median Arcuate Ligament Release in 26 Patients

Nathan G Richards, MD, Richard Amdur, PhD, Richard Neville, MD, Anton Sidawy, MD, MPH, Frederick J Brody, MD, MBA

George Washington University Medical Center

INTRODUCTION: Celiac Artery Compression (CAC) syndrome or Median Arcuate Ligament Syndrome (MALS) was first described in 1963. MALS has remained somewhat ambiguous and difficult to definitively diagnose and treat. This is due to limited data with various treatments. Due to this variability, it is difficult to evaluate clinical outcomes of these patients.

METHODS AND PROCEDURES: 26 consecutive patients who underwent MAL release were analyzed. Pre- and postoperative celiac ultrasounds were obtained. This video details the surgical technique and the results of follow up in 26 patients.

RESULTS: Data were available from 26 patients pre-treatment and 16 patients post-treatment. Patients with follow-up data were not significantly different at pre-treatment from those without follow-up data. There was one operative conversion to an open laparotomy. Length of stay ranged from 1-9 days. There were no intra-operative complications. Six patients required re-admission for tachycardia, pancreatitis, or a segmental pulmonary embolus. All six pateints were treated non-operatively. At this time, no patient has required re-operative therapy for recurrent symptoms.

CONCLUSION: Laparoscopic MAL release is safe and associated with minimal complications. Based on our experience, we feel that the etiology of MALS is a neurogenic process with compression of the celiac plexus that presents as CAC. Hence, the critical step to the procedure requires division of the celiac plexus. Pre-operative selection is critical to enhance patient outcomes.

Session: Podium Presentation

Program Number: V017