Single-institution Experience with Laparoscopic Median Arcuate Ligament Release

Konstantinos Spaniolas, MD, Michael B Hill, MD, Thadeus L Trus, MD

DARTMOUTH-HITCHCOCK MEDICAL CENTER

INTRODUCTION: Celiac axis syndrome is associated with abdominal pain and weight loss as a result of extrinsic compression of the celiac artery by the median arcuate ligament. The objective of this study was to evaluate the short and long-term outcomes associated with laparoscopic median arcuate ligament release (LMALR).

METHODS AND PROCEDURES: This is a retrospective single-institution study reporting the experience with LMALR. Patients were identified within the hospital administrative database. Demographic, diagnostic and perioperative data were collected, as well as details from follow-up assessments. Descriptive statistics were performed and results are presented as number (percentage) or median (range).

RESULTS: Seven patients were identified; six (86%) were female and the median age was 28 (20 – 50). All patients presented with abdominal pain, and five (71%) reported associated weight loss.The diagnosis was established with two imaging modalities in all but one patient: CT and digital subtraction angiography in one, Duplex ultrasound and MR angiography in one, MR angiography alone in one, and Duplex ultrasound with digital subtraction angiography in four. Blood loss was less than 25 ml in six (86%) and 350 ml in one patient. Hospital length of stay was one day (0 – 1). There was no 30-day morbidity or mortality related to the LMALR. The patients were followed for 19 months (2 – 24). One patient had complete resolution of symptoms, four reported partial or temporary improvement, and two had no improvement. Overall, LMALR was associated with partial or complete symptomatic improvement in five (71%) patients. Three patients (43%) with temporary symptomatic improvement underwent endovascular dilatation and stent placement. Vascular bypass was performed in two of these patients, neither of which achieved sustainable long-term symptomatic relief.

CONCLUSIONS: Based on our experience, LMALR is associated with minimal in-hospital recovery, no morbidity and no mortality. Short-term symptomatic improvement is common, but the long-term results are suboptimal despite multi-modality therapy. Large volume studies are required to assess the natural history of this disease, and optimal management.

Session: Poster Presentation

Program Number: P550