Median arcuate ligament syndrome: case presentation and video-illustrated laparoscopic management.

Laparoscopic release of the median arcuate ligament, to relieve symptomatic compression of the celiac trunk, is the ideal approach when performed in a specialized center, by a surgeon with the adequate experience in advanced laparoscopic surgery.

Median arcuate ligament syndrome (MALS) is caused by compression of the celiac trunk, due to either an unusually high located celiac axis or low inserted median arcuate ligament (MAL) 1. The main presentation is postprandial abdominal pain, vomiting, and weight loss. MALS is a diagnosis of exclusion. Our patient presented with the abovementioned symptoms. An angiographic CT scan revealed celiac artery compression. The best treatment modality is release of the MAL fibers compressing the artery 2. We adopted the laparoscopic approach and successfully released the ligament fibers. This short video shows the most important and challenging operative steps (Fig. 1).

Figure 1

Laparoscopic release of median arcuate ligament.

Conflict of Interest

None declared.

Authorship

AEA: surgeon assistant, article writer and video editor ZER: surgeon, tutor and reviewer.

Video S1. Laparoscopic release of median arcuate ligament.

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