Laparoscopic Ligament Release for Median Arcuate Ligament Syndrome

Abstract

In recent years, while numerous cases of laparoscopic surgery for median arcuate ligament syndrome (MALS) have been reported, awareness about the need to include MALS in the differential diagnosis of abdominal pain is still lacking. Herein, we describe the case of a 52-year-old woman who was diagnosed as having MALS based on the findings of expiratory contrast-enhanced CT performed in the course of detailed examination to identify the cause of abdominal pain. The operation was performed laparoscopically by incising the lesser omentum to approach the median arcuate ligament, and the ligament was divided until the adventitia from the abdominal aorta to the celiac artery was visualized. Postoperatively, the abdominal symptoms improved, and contrast-enhanced CT showed improvement of the celiac artery stenosis. This treatment for MALS is closely related to vascular surgery, and arterial injury is a serious intraoperative complication. Although surgery can be expected to improve symptoms, there remains the need to establish safe surgical techniques and measures to deal with complications, and to raise awareness about the condition itself.