Seda Dzhantukhanova, MD, PhD, Yury Starkov, prof, PhD, Mikhail Vyborniy, MD, PhD, Nadezhda Glagoleva, MD. Vishnevsky Institute of Surgery
Background: The study aims to assess the feasibility and midterm outcome of laparoscopic treatment of celiac artery compression syndrome. The tips and tricks to obtain a better exposure and a safer procedure are described.
Materials and methods: In a period from 2005 to 2015, 16 patients underwent laparoscopic decompression of the celiac trunk, using standard laparoscopic transperitoneal approach. There were 10 females and 6 males with median age of 43,8 + 16,2 (28-72) years. All patients had a history of postprandial abdominal pain and weight loss exceeded 10% of the body mass. As a part of the search for more common causes of upper abdominal pain, upper GI endoscopy and abdominal ultrasound were performed in all patients without conclusive results. Preoperative CT angiography and duplex scan revealed hemodynamically relevant stenosis of the celiac trunk > 70 % in all cases (median 77,5%, range 55-90% + 13,2).
All procedures were carried out under general anesthesia. Patients were placed in a supine split-leg reverse Trendelenburg position. Five (5 and 10-mm) troacars were typically placed as for a fundoplication. A liver retractor was used to retract the left liver lobe laterally. The avascular region of the gastohepatic omentum was divided and the right crus of the diaphragm was identified. To get a better exposure of aortoceliac region the stomach was retracted to the patient’s left side with an atraumatic grasper through a 5-mm port in the left flank.
The muscular fibers of the crural decussation were divided with ultrasonic scissors to expose the median arcuate ligament. The ligament was cut using coagulating hook, which permitted elevation of the fibers from the aortic wall as they divide. A 10-mm laparoscopic Doppler ultrasound scanning probe was used to assess the improvement of the flow in the celiac artery.
Results: Median operating time was 170 min. Recovery was uneventful and median post-op hospital stay was 6 + 2,4 (2-9) days. Post-op assessment include evaluation of the complaints, the results of CT-angiography and duplex ultrasound. The mean follow-up period was 35 months (range 3-60 months). The symptoms improved in all patients in early post-op period. Symptoms reappeared in one patient due to celiac artery occlusion, treated by percutaneous angioplasty.
Conclusion: The study demonstrates the feasibility of laparoscopic approach in the treatment of median arcuate compression syndrome. Additional patients and longer follow-up are needed for long-term assessment of this technique.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 78758
Program Number: P607
Presentation Session: Poster (Non CME)
Presentation Type: Poster
