Systematic hybrid laparoscopic and endovascular treatment of median arcuate ligament syndrome: A single-center experience
BackgroundMedian arcuate ligament syndrome (MALS) is caused by celiac trunk (CT) compression by the median arcuate ligament. Clinically, this pathology varies from postprandial pain (Dunbar syndrome) to a life-threatening hemorrhage because of a rupture of a gastroduodenal artery aneurysm (GAA). Due...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2023-04-01
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| Series: | Frontiers in Surgery |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fsurg.2023.1169681/full |
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| author | Michael Schneider Justine Longchamp Emilie Uldry Jean-Marc Corpataux Amaniel Kefleyesus Nermin Halkic |
| author_facet | Michael Schneider Justine Longchamp Emilie Uldry Jean-Marc Corpataux Amaniel Kefleyesus Nermin Halkic |
| author_sort | Michael Schneider |
| collection | DOAJ |
| description | BackgroundMedian arcuate ligament syndrome (MALS) is caused by celiac trunk (CT) compression by the median arcuate ligament. Clinically, this pathology varies from postprandial pain (Dunbar syndrome) to a life-threatening hemorrhage because of a rupture of a gastroduodenal artery aneurysm (GAA). Due to the low prevalence of this disease, there is no standard management for MALS.Material and methodThis was a single-center, retrospective study of 13 patients. Two groups were identified on the basis of the initial clinical presentation: those operated for a GAA rupture (bleeding group—BG) and those operated electively for Dunbar syndrome (Dunbar syndrome group—DG). The primary endpoint was 30-day postoperative complications of a systematic laparoscopic release of the median arcuate ligament and stenting during the same procedure.ResultsSeven patients (54%) underwent elective surgery. Six patients (46%) underwent semiurgent repair under elective conditions post-embolization for GAA bleeding. The total operative time was longer in the BG (p = 0.06). Two patients in the BG suffered early major complications and needed reintervention, and those in the DG had a lower comprehensive complication index. No mortality was reported at 30 days. Overall median length of stay was 5 days (IQR: 3.5–15.3). Patients in the DG had a significantly shorter length of stay (p = 0.02). At 6 months, the primary and secondary CT stent patencies were 82% and 100%, respectively. There were no high-flow GAA recurrences.ConclusionsA combined approach of laparoscopic release of the median arcuate ligament and stenting during the same procedure is feasible and safe, and this approach must be systematically discussed in symptomatic patients. |
| first_indexed | 2024-04-09T17:19:50Z |
| format | Article |
| id | doaj.art-c82d232da37e45e4ad73d149826f697b |
| institution | Directory Open Access Journal |
| issn | 2296-875X |
| language | English |
| last_indexed | 2024-04-09T17:19:50Z |
| publishDate | 2023-04-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Surgery |
| spelling | doaj.art-c82d232da37e45e4ad73d149826f697b2023-04-19T04:52:41ZengFrontiers Media S.A.Frontiers in Surgery2296-875X2023-04-011010.3389/fsurg.2023.11696811169681Systematic hybrid laparoscopic and endovascular treatment of median arcuate ligament syndrome: A single-center experienceMichael Schneider0Justine Longchamp1Emilie Uldry2Jean-Marc Corpataux3Amaniel Kefleyesus4Nermin Halkic5Department of Visceral Surgery, Lausanne University Hospital and University of Lausanne, Lausanne, SwitzerlandDepartment of Vascular Surgery, Lausanne University Hospital and University of Lausanne, Lausanne, SwitzerlandDepartment of Visceral Surgery, Lausanne University Hospital and University of Lausanne, Lausanne, SwitzerlandDepartment of Vascular Surgery, Lausanne University Hospital and University of Lausanne, Lausanne, SwitzerlandDepartment of Visceral Surgery, Lausanne University Hospital and University of Lausanne, Lausanne, SwitzerlandDepartment of Visceral Surgery, Lausanne University Hospital and University of Lausanne, Lausanne, SwitzerlandBackgroundMedian arcuate ligament syndrome (MALS) is caused by celiac trunk (CT) compression by the median arcuate ligament. Clinically, this pathology varies from postprandial pain (Dunbar syndrome) to a life-threatening hemorrhage because of a rupture of a gastroduodenal artery aneurysm (GAA). Due to the low prevalence of this disease, there is no standard management for MALS.Material and methodThis was a single-center, retrospective study of 13 patients. Two groups were identified on the basis of the initial clinical presentation: those operated for a GAA rupture (bleeding group—BG) and those operated electively for Dunbar syndrome (Dunbar syndrome group—DG). The primary endpoint was 30-day postoperative complications of a systematic laparoscopic release of the median arcuate ligament and stenting during the same procedure.ResultsSeven patients (54%) underwent elective surgery. Six patients (46%) underwent semiurgent repair under elective conditions post-embolization for GAA bleeding. The total operative time was longer in the BG (p = 0.06). Two patients in the BG suffered early major complications and needed reintervention, and those in the DG had a lower comprehensive complication index. No mortality was reported at 30 days. Overall median length of stay was 5 days (IQR: 3.5–15.3). Patients in the DG had a significantly shorter length of stay (p = 0.02). At 6 months, the primary and secondary CT stent patencies were 82% and 100%, respectively. There were no high-flow GAA recurrences.ConclusionsA combined approach of laparoscopic release of the median arcuate ligament and stenting during the same procedure is feasible and safe, and this approach must be systematically discussed in symptomatic patients.https://www.frontiersin.org/articles/10.3389/fsurg.2023.1169681/fullmedian arcuate ligament syndromeceliac trunk compressionDunbar syndromeendovascular treatmentminimally invasive surgerylaparoscopic surgery |
| spellingShingle | Michael Schneider Justine Longchamp Emilie Uldry Jean-Marc Corpataux Amaniel Kefleyesus Nermin Halkic Systematic hybrid laparoscopic and endovascular treatment of median arcuate ligament syndrome: A single-center experience Frontiers in Surgery median arcuate ligament syndrome celiac trunk compression Dunbar syndrome endovascular treatment minimally invasive surgery laparoscopic surgery |
| title | Systematic hybrid laparoscopic and endovascular treatment of median arcuate ligament syndrome: A single-center experience |
| title_full | Systematic hybrid laparoscopic and endovascular treatment of median arcuate ligament syndrome: A single-center experience |
| title_fullStr | Systematic hybrid laparoscopic and endovascular treatment of median arcuate ligament syndrome: A single-center experience |
| title_full_unstemmed | Systematic hybrid laparoscopic and endovascular treatment of median arcuate ligament syndrome: A single-center experience |
| title_short | Systematic hybrid laparoscopic and endovascular treatment of median arcuate ligament syndrome: A single-center experience |
| title_sort | systematic hybrid laparoscopic and endovascular treatment of median arcuate ligament syndrome a single center experience |
| topic | median arcuate ligament syndrome celiac trunk compression Dunbar syndrome endovascular treatment minimally invasive surgery laparoscopic surgery |
| url | https://www.frontiersin.org/articles/10.3389/fsurg.2023.1169681/full |
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