Minimally Invasive Approach & Key Aspects For The Treatment of Median Arcuate Ligament Syndrome: Case Report

Abstract

[eng] Background: Median arcuate ligament syndrome (MALS) is a rare condition resulting from the external compression of the celiac artery by an abnormally downward located media arcuate ligament (MAL). The aim of this video is to illustrate the key steps for minimally invasive approach for the surgical treatment of MALS. Case Description: We present the case of an 18 years old female without any important past medical history referring 1 year of postprandial epigastric pain associated with weight-loss. After normal complementary tests, computed tomography (CT) scan showed 60% celiac trunk stenosis with post-stenotic dilation. Surgical approach started with two 5 mm, one 11 mm and one 12 mm laparoscopy trocars. Opening the pars flaccida of the lesser omentum and separating the right crus from the esophagus gives access to the abdominal aorta. Additional care must be taken to avoid injury of the branches of the celiac trunk, especially the common hepatic and left gastric arteries. Careful dissection of adhesions using laparoscopic sealer and hook cautery gives access to the fibrous tissue of the MAL. Finally, as when the musculo-fibrous structure of MAL is seen it must be divided until the celiac trunk is freed completely and its branches are seen. Surgical time was 1 hour 33 minutes long with no blood loss. Post-operative was uneventful (Clavien-Dindo: 0) and the patient was discharged at 48 hours from the admission. During the follow-up, the patient presented adequate oral intake without epigastric postprandial pain. Conclusions: Minimally invasive approach for MAL release is feasible, effective and safe following key steps and paying attention to vascular the structures near the celiac trunk. Keywords: Median arcuate ligament syndrome (MALS); minimally invasive surgical procedures; laparoscopy; case report