Median Arcuate Ligament Syndrome: Minimally Invasive Release
Ali Khalifeh, MD, Shahab Toursavadkohi, MD, Khanjan Nagarsheth, MD, Rajabrata Sarkar, MD PhD, Stephen M. Kavic, MD.
University of Maryland Medical Center, Baltimore, MD, USA.
Median arcuate ligament syndrome is a rare constellation of symptoms related to the compression of the celiac trunk. The diagnosis is made by exclusion of other pathologies and imaging. Minimally invasive release can provide a cure. Diagnosis is confirmed by duplex ultrasound, and angiography. After appropriate screening and diagnosis, the patient is counseled about surgical intervention. Laparoscopic release is our approach to divide the fibrous tissue band surround the celiac trunk. The patient is placed in low lithotomy. After pneumoperitoneum is established, a sub-xiphoid port is used to retract the left lobe of the liver. Four other ports are placed along the umbilical line to allow for surgeon and assistant ports. The hepatic artery is dissected proximally above the lesser curvature. The dissection is carried until celiac trunk is identified with its major branches. The trunk is then dissected by dividing all fibrous and nerve tissues surrounding it down to its origin from the aorta. The celiac trunk will appear free and elevates easily into the surgical feed when appropriately released. After ensuring hemostasis the ports are removed. Postoperative studies can confirm improved flow within the vessel and the patient is followed for clinical improvement.
Back to 2020 Abstracts