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Laparoscopic median arcuate ligament release

Epublication WebSurg.com, Feb 2015;15(02). URL: http://websurg.com/doi/vd01en4423

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  • 2015-02-13
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The video demonstrates the case of a laparoscopic median arcuate ligament release for a patient presenting with median arcuate ligament syndrome. This is a 37-year-old woman who was admitted to our clinic with complaints of intermittent abdominal pain, especially with meals, for 3 years’ duration. Her physical examination was unremarkable, except for an epigastric bruit detected on auscultation. Investigations included a duplex ultrasound, which showed increased hemodynamic velocities in the celiac trunk. In addition, CT-angiogram of the abdomen revealed an 80% luminal narrowing and extrinsic compression of the celiac artery at its origin. Her symptoms could be a result of foregut ischemia caused by the vessel’s narrowing. A potential anatomical factor contributing to extrinsic compression is the median arcuate ligament. This video explains our operative approach and technique used to dissect the esophagus at the hiatus, creating a subsequent pathway to identify the median arcuate ligament inferiorly and transect it down to the level of the celiac trunk’s origin. This will allow for relief of the external vascular compression and increased blood flow to the foregut and relief of her abdominal pain. Postoperatively, the patient had complete resolution of her abdominal symptoms.