Robert A Grossman, MD, Fred Brody, MD, MBA. George Washington University
Introduction: Bariatric surgery is commonly performed throughout the United States. Many patients may experience post-operative pain secondary to internal hernias, gallbladder disease, and marginal ulceration. However, weight loss and the change of the geometry of the celiac artery axis can result in median arcuate ligament syndrome (MALS). This disease, while rare, can result in nausea, emesis, and post-prandial pain. Two patients are presented who were referred for MALS after a laparoscopic roux-en-y gastric bypass. Their clinical presentation and subsequent treatment with a laparoscopic MAL release is detailed in this video.
Methods: Two patients presented to our clinic with signs and symptoms of MALS. MALS was confirmed by ultrasonography and radiologic (MRA/CT) findings. Both patients underwent a laparoscopic MAL release. The attached video demonstrates the surgical technique.
Results: Both patients reported improvement in their symptoms of abdominal pain, nausea, and emesis post-operatively. As well, both patients were able to resume regular oral intake without post-prandial pain.
Conclusion: MALS is a rare etiology that may be responsible for post-bariatric abdominal pain, after exclusion of more common causes of pain. These cases serve to illustrate that a laparoscopic MAL release can be safely performed in patients who have undergone bariatric surgery. A low threshold should exist to obtain a celiac artery ultrasound in post-bariatric surgery presenting with abdominal pain of unknown etiology.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79872
Program Number: V028
Presentation Session: Thursday Exhibit Hall Video Presentations Session 1 (Non CME)
Presentation Type: EHVideo