REVIEW  VISCERAL ARTERIAL DISEASE Free access

International Angiology 2019 December;38(6):474-83

DOI: 10.23736/S0392-9590.19.04161-0

Copyright © 2019 EDIZIONI MINERVA MEDICA

language: English

Laparoscopic treatment of median arcuate ligament syndrome: a systematic review

Enrique M. SAN NORBERTO ¹ ✉, Alejandro ROMERO ², Liliana A. FIDALGO-DOMINGOS ¹, Irene GARCÍA-SAIZ ³, James TAYLOR ⁴, Carlos VAQUERO ¹

¹ Department Vascular Surgery, Valladolid University Hospital, Valladolid, Spain; ² Department of General Surgery, Valladolid University Hospital, Valladolid, Spain; ³ Department of Anesthesia and Critical Care, Rio Hortega University Hospital, Valladolid, Spain; ⁴ Department of Cardiac Surgery, Valencia General University Hospital, Valencia, Spain

INTRODUCTION: Median arcuate ligament syndrome (MALS) is an uncommon condition caused by the extrinsic compression of the celiac trunk (CT) and celiac ganglion, secondary to an anatomical abnormality of the median arcuate ligament fibers. It is characterized by postprandial epigastric pain, chronic abdominal pain, weight loss, nausea and vomiting. MALS is typically diagnosed after the exclusion of other, more common conditions; however, a variety of imaging and diagnostic modalities, including Duplex ultrasonography, computed tomography angiography, magnetic resonance angiography, gastric tonometry and angiography can suggest findings consistent with MALS.
EVIDENCE ACQUISITION: Laparoscopic approach has been proposed as the option of choice for the treatment of these patients. A systematic review of the international literature regarding this modality of treatment is presented here.
EVIDENCE SYNTHESIS: The review included 504 cases, and several principles are suggested to improve the management. The advantages of this minimally invasive technique include short operative time (136.0 minutes, range 70-242), shorter hospital stay (3.8 days, range 0.5-7) and low rate of conversion to open surgery (4.2%).
CONCLUSIONS: Various treatment modalities are available to decompress the celiac trunk. Although open surgery has been traditionally accepted as the gold standard, laparoscopic division of the MALS has proven equal results. Others have described different treatment modalities, including bypass surgery and endovascular procedures (angioplasty or stent placement). Laparoscopic approaches to correct MALS are feasible and safe. It may be the preferred modality of treatment in view of its lack of morbidity, shorter hospital stay and good results.

KEY WORDS: Median arcuate ligament syndrome; Laparoscopy; Conversion to open surgery; Intraoperative complications; Endovascular procedures