Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Journal of Gastrointestinal Surgery
Published in: Journal of Gastrointestinal Surgery 4/2018

01-04-2018 | Original Article

Laparoscopic Treatment of Median Arcuate Ligament Syndrome: Analysis of Long-Term Outcomes and Predictive Factors

Authors: Javier A. Cienfuegos, Mateo G. Estevez, Miguel Ruiz-Canela, Fernando Pardo, Alberto Diez-Caballero, Isabel Vivas, Jose Ignacio Bilbao, Pablo Martí-Cruchaga, Gabriel Zozaya, Víctor Valentí, José Luis Hernández-Lizoáin, Fernando Rotellar

Published in: Journal of Gastrointestinal Surgery | Issue 4/2018

Login to get access

Abstract

Background

Laparoscopic arcuate ligament release has been demonstrated a valid therapeutic option for arcuate ligament syndrome. Nevertheless, long-term follow-up and predictive factors have not been described for this treatment.

Methods

Clinical and surgical data and short- and long-term outcomes together with the impact of the degree of stenosis of the celiac trunk were analyzed in 13 consecutive patients who underwent laparoscopic arcuate ligament release between 2001 and 2013.

Results

Thirteen patients (12 F/1 M) underwent surgery. The median age was 32 years old, and their mean body mass index was 20.7 (range 14.7–25). The 13 patients presented with intense postprandial abdominal pain. Ten cases were associated with weight loss. The median duration of symptoms was 24 months (range 2–240). Three patients presented symptoms associated with superior mesenteric artery syndrome. Median operative time was 120 min (range 90–240), and there were no conversions to open surgery. Median hospital stay was 3 days (range 2–14). Over a median follow-up of 117 months (range 45–185), nine patients had excellent results although two required endovascular procedures at 70 and 24 months after surgery. Four patients (30.7%) experienced poor outcomes. When we analyzed the impact of the degree of occlusion of the celiac trunk, we observed that in patients with severe occlusion (> 70%), better results were obtained, with complete resolution of symptoms in 71% of cases.

Conclusion

Laparoscopic arcuate ligament release constitutes an excellent treatment for arcuate ligament syndrome. The degree of occlusion of the celiac trunk may be a factor predictive of long-term outcomes.
Literature
1.
Loukas M, Pinyard J, Vaid S, Kinsella C, Tariq A, Tubbs RS. Clinical anatomy of celiac artery compression syndrome: a review. Clin Anat 2007; 20:612–7.CrossRefPubMed
2.
Harjola pt. A rare obstruction of the coeliac artery. report of a case. Ann Chir Gynaecol Fenn 1963; 52:547–50.PubMed
3.
A-Cienfuegos J, Rotellar F, Valentí V, Arredondo J, Pedano N, Bueno A, Vivas I. The celiac axis compression syndrome (CACS): critical review in the laparoscopic era. Rev Esp Enferm Dig 2010; 102:193–201.PubMed
4.
Kim EN, Lamb K, Relles D, Moudgill N, DiMuzio PJ, Eisenberg JA. Median Arcuate Ligament Syndrome-Review of This Rare Disease. JAMA Surg 2016; 151:471–7.CrossRefPubMed
5.
Dunbar JD, Molnar W, Beman FF, Marable SA. Compression of the celiac trunk and abdominal angina. Am J Roentgenol Radium Ther Nucl Med 1965; 95:731–44.CrossRefPubMed
6.
Roayaie S, Jossart G, Gitlitz D, Lamparello P, Hollier L, Gagner M. Laparoscopic release of celiac artery compression syndrome facilitated by laparoscopic ultrasound scanning to confirm restoration of flow. J Vasc Surg 2000; 32:814–7.CrossRefPubMed
7.
van Petersen AS, Vriens BH, Huisman AB, Kolkman JJ, Geelkerken RH. Retroperitoneal endoscopic release in the management of celiac artery compression syndrome. J Vasc Surg 2009; 50:140–7.CrossRefPubMed
8.
Baccari P, Civilini E, Dordoni L, Melissano G, Nicoletti R, Chiesa R. Celiac artery compression syndrome managed by laparoscopy. J Vasc Surg 2009; 50:134–9.CrossRefPubMed
9.
Roseborough GS. Laparoscopic management of celiac artery compression syndrome. J Vasc Surg 2009; 50:124–33.CrossRefPubMed
10.
Berard X, Cau J, Déglise S, Trombert D, Saint-Lebes B, Midy D, Corpataux JM, Ricco JB. Laparoscopic surgery for coeliac artery compression syndrome: current management and technical aspects. Eur J Vasc Endovasc Surg 2012; 43:38–42.CrossRefPubMed
11.
El-Hayek KM, Titus J, Bui A, Mastracci T, Kroh M. Laparoscopic median arcuate ligament release: are we improving symptoms? J Am Coll Surg 2013; 216:272–9.CrossRefPubMed
12.
Thoolen SJJ, van der Vliet WJ, Kent TS, Callery MP, Dib MJ, Hamdan A, Schermerhorn ML, Moser AJ. Technique and outcomes of robot-assisted median arcuate ligament release for celiac artery compression syndrome. J Vasc Surg 2015; 61:1278–84.CrossRefPubMed
13.
Columbo JA, Trus T, Nolan B, Goodney P, Rzucidlo E, Powell R, Walsh D, Stone D. Contemporary management of median arcuate ligament syndrome provides early symptom improvement. J Vasc Surg 2015; 62:151–6.CrossRefPubMedPubMedCentral
14.
Horton KM, Talamini MA, Fishman EK Median arcuate ligament syndrome: evaluation with CT angiography. Radiographics 2005; 25:1177–82.CrossRefPubMed
15.
Tracci MC. Median arcuate ligament compression of the mesenteric vasculature. Tech Vasc Interv Radiol 2015; 18:43–50.CrossRefPubMed
16.
New classification of physical status. Anesthesiology 1963; 24:111.
17.
Ilica AT, Kocaoglu M, Bilici A, Ors F, Bukte Y, Senol A, Ucoz T, Somuncu I Median arcuate ligament syndrome: multidetector computed tomography findings. J Comput Assist Tomogr 2007; 31:728–31.PubMed
18.
Jaik NP, Stawicki SP, Weger NS, Lukaszczyk JJ. Celiac artery compression syndrome: successful utilization of robotic-assisted laparoscopic approach. J Gastrointestin Liver Dis 2007; 16:93–6.PubMed
19.
Do M V, Smith TA, Bazan HA, Sternbergh WC, Abbas AE, Richardson WS. Laparoscopic versus robot-assisted surgery for median arcuate ligament syndrome. Surg Endosc 2013; 27:4060–6.CrossRefPubMed
20.
Relles D, Moudgill N, Rao A, Rosato F, DiMuzio P, Eisenberg J. Robotic-assisted median arcuate ligament release. J Vasc Surg 2012; 56:500–3.CrossRefPubMed
21.
Pottorf BJ, Husain FA, Hollis HW, Lin E. Laparoscopic management of duodenal obstruction resulting from superior mesenteric artery syndrome. JAMA Surg 2014; 149:1319–22.CrossRefPubMed
22.
Modlin IM, Oberg K, Chung DC, Jensen RT, de Herder WW, Thakker R V, Caplin M, Delle Fave G, Kaltsas GA, Krenning EP, Moss SF, Nilsson O, Rindi G, Salazar R, Ruszniewski P, Sundin A. Gastroenteropancreatic neuroendocrine tumours. The LancetOncology 2008; 9:61–72.
23.
Duffy AJ, Panait L, Eisenberg D, Bell RL, Roberts KE, Sumpio B Management of median arcuate ligament syndrome: a new paradigm. Ann Vasc Surg 2009; 23:778–84.CrossRefPubMed
24.
Riess KP, Serck L, Gundersen SB, Sergi M, Kothari SN. Seconds from disaster: lessons learned from laparoscopic release of the median arcuate ligament. Surg Endosc 2009; 23:1121–4.CrossRefPubMed
25.
Weber JM, Boules M, Fong K, Abraham B, Bena J, El-Hayek K, Kroh M, Park WM. Median Arcuate Ligament Syndrome Is Not a Vascular Disease. Ann Vasc Surg 2016; 30:22–7.CrossRefPubMed
26.
Tulloch AW, Jimenez JC, Lawrence PF, Dutson EP, Moore WS, Rigberg DA, Derubertis BG, Quinones-Baldrich WJ. Laparoscopic versus open celiac ganglionectomy in patients with median arcuate ligament syndrome. J Vasc Surg 2010; 52:1283–9.CrossRefPubMed
27.
Reilly LM, Ammar AD, Stoney RJ, Ehrenfeld WK. Late results following operative repair for celiac artery compression syndrome. J Vasc Surg 1985; 2:79–91.CrossRefPubMed
28.
Evans WE. Long-term evaluation of the celiac band syndrome. Surgery 1974; 76:867–71.PubMed
29.
Jimenez JC, Harlander-Locke M, Dutson EP. Open and laparoscopic treatment of median arcuate ligament syndrome. J Vasc Surg 2012; 56:869–73.CrossRefPubMed
30.
Desmond CP, Roberts SK. Exercise-related abdominal pain as a manifestation of the median arcuate ligament syndrome. Scand J Gastroenterol 2004; 39:1310–3.CrossRefPubMed
31.
Tseng Y-C, Tseng C-K, Chou J-W, Lai H-C, Hsu C-H, Cheng K-S, Peng C-Y, Chen Y-F. A rare cause of mesenteric ischemia: celiac axis compression syndrome. Intern Med 2007; 46:1187–90.CrossRefPubMed
32.
Harr JN, Haskins IN, Brody F. Median arcuate ligament syndrome in athletes. Surg Endosc. 2017; 31(1):476.CrossRefPubMed
33.
Someya N, Endo MY, Fukuba Y, Hayashi N. Blood flow responses in celiac and superior mesenteric arteries in the initial phase of digestion. AJP Regul Integr Comp Physiol 2008; 294:R1790–R1796.CrossRef
34.
Gatt M, MacFie J, Anderson ADG, Howell G, Reddy BS, Suppiah A, Renwick I, Mitchell CJ. Changes in superior mesenteric artery blood flow after oral, enteral, and parenteral feeding in humans. Crit Care Med 2009; 37:171–6.CrossRefPubMed
35.
Arazińska A, Polguj M, Wojciechowski A, Trębiński Ł, Stefańczyk L. Median arcuate ligament syndrome: Predictor of ischemic complications? Clin Anat 2016; 29:1025–1030.CrossRefPubMed
36.
37.
Gloviczki P, Duncan AA. Treatment of celiac artery compression syndrome: does it really exist? Perspect Vasc Surg Endovasc Ther 2007; 19:259–63.CrossRefPubMed
38.
Sugae T, Fujii T, Kodera Y, Kanzaki A, Yamamura K, Yamada S, Sugimoto H, Nomoto S, Takeda S, Nakao A. Classification of the celiac axis stenosis owing to median arcuate ligament compression, based on severity of the stenosis with subsequent proposals for management during pancreatoduodenectomy. Surgery 2012; 151:543–9.CrossRefPubMed
39.
Fukuzawa K, Schwartz ME, Katz E, Mor E, Emre S, Acarli K, Miller CM. The arcuate ligament syndrome in liver transplantation. Transplantation 1993; 56:223–4.CrossRefPubMed
40.
de Moya MA, Reisner AT, LaMuraglia GM, Kalva SP, Cort AM, Ebeling SH, Peters CC, de Moya MA, Reisner AT, LaMuraglia GM, Kalva SP. Case records of the Massachusetts General Hospital. Case 1-2008. A 45-year-old man with sudden onset of abdominal pain and hypotension. N Engl J Med 2008; 358:178–86.CrossRefPubMed
41.
Habre J, Bernard J-L, Bereder J-M, Rahili A, Benchimol D, Bourgeon A. Rupture of a pancreaticoduodenal artery aneurysm with median arcuate ligament syndrome: report of a case. Ann Chir 2005; 130:178–80.CrossRefPubMed
42.
Merrett ND, Wilson RB, Cosman P, Biankin A V. Superior mesenteric artery syndrome: diagnosis and treatment strategies. J Gastrointest Surg 2009; 13:287–92.CrossRefPubMed
43.
Chou JW, Lin CM, Feng CL, Ting CF, Cheng KS, Chen YF. Celiac artery compression syndrome: an experience in a single institution in taiwan. Gastroenterol Res Pract. 2012;2012:935721.CrossRefPubMedPubMedCentral
44.
Richards NG, Neville RF, Sidawy AN, Brody FJ. Celiac artery compression after a gastric bypass. Surg Laparosc Endosc Percutan Tech 2014; 24:e66–9.CrossRefPubMed
Metadata
Title
Laparoscopic Treatment of Median Arcuate Ligament Syndrome: Analysis of Long-Term Outcomes and Predictive Factors
Authors
Javier A. Cienfuegos
Mateo G. Estevez
Miguel Ruiz-Canela
Fernando Pardo
Alberto Diez-Caballero
Isabel Vivas
Jose Ignacio Bilbao
Pablo Martí-Cruchaga
Gabriel Zozaya
Víctor Valentí
José Luis Hernández-Lizoáin
Fernando Rotellar
Publication date
01-04-2018
Publisher
Springer US
Published in
Journal of Gastrointestinal Surgery / Issue 4/2018
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI
https://doi.org/10.1007/s11605-017-3635-3

Other articles of this Issue 4/2018

Journal of Gastrointestinal Surgery 4/2018 Go to the issue

Original Article

Incidental Gallbladder Carcinoma Discovered after Laparoscopic Cholecystectomy: Identifying Patients Who will Benefit from Reoperation

Original Article

Right-Side Approach-Duet Totally Laparoscopic Distal Gastrectomy (R-Duet TLDG) Using a Three-Port to Treat Gastric Cancer

GI Image

Duodenal Crohn’s Disease—a Diagnostic Conundrum

2017 SSAT Plenary Presentation

Incidence, Survival, and Predictors of Lymph Node Involvement in Early-Stage Gastric Signet Ring Cell Carcinoma in the US

Original Article

Prognostic Significance of Serum Inflammatory Markers in Gastric Cancer

Original Article

Association of Adjuvant Therapy with Improved Survival in Ampullary Cancer: A National Cohort Study