Laparoscopic median arcuate ligament release using an anterior approach for median arcuate ligament syndrome

IF 2.9 4区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY
Koji Kubota, Akira Shimizu, Tsuyoshi Notake, Satoshi Nakamura, Yuji Soejima
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Abstract

Median arcuate ligament syndrome (MALS) is a rare condition characterized by nonspecific symptoms, such as abdominal pain, nausea, and vomiting. Furthermore, the development and rupture of pancreaticoduodenal artery aneurysms pose a potentially fatal risk. Median arcuate ligament release (MALR) is useful in the treatment of MALS, with most procedures performed laparoscopically. However, detailed descriptions of laparoscopic MALR (lap-MALR) procedures are rare. In this study, we performed lap-MALR via an anterior approach with dissection of the right lateral wall of the celiac artery (CA). For optimal visualization of the right side of the CA, the right branch of the inferior phrenic artery was divided. We believe that this procedure allows the MAL to be released within a sufficient surgical field and without excess or deficiency. Here, we present the details of six patients who underwent lap-MALR for varying indications; three for pancreaticoduodenal artery aneurysms due to CA obstruction (unruptured, n = 1; ruptured, n = 2), two cases prior to hepato-biliary-pancreatic surgery, and one symptomatic case. In all cases, lap-MALR was performed as described above, and the CA stenosis was successfully released. Our case series demonstrates the safety and reliability of our lap-MALR procedure in the treatment of MALS-related disorders, including pancreaticoduodenal artery aneurysms associated with CA compression.

Abstract Image

腹腔镜正中弓状韧带松解术,采用前路治疗正中弓状韧带综合征。
弧中韧带综合征(MALS)是一种罕见疾病,以腹痛、恶心和呕吐等非特异性症状为特征。此外,胰十二指肠动脉瘤的发生和破裂可能带来致命风险。正中弓状韧带松解术(MALR)可用于治疗 MALS,大多数手术都是在腹腔镜下进行的。然而,有关腹腔镜 MALR(腹腔镜 MALR)手术的详细描述并不多见。在本研究中,我们通过腹腔前路进行腹腔镜 MALR,并对腹腔动脉(CA)右侧壁进行解剖。为了获得腹腔动脉右侧的最佳视野,我们分割了膈下动脉的右侧分支。我们认为,这种手术方法可以在足够的手术视野内释放 MAL,且不会出现多余或不足的情况。在此,我们介绍了六例因不同适应症而接受腹腔镜-MALR的患者的详细情况,其中三例是因CA阻塞导致的胰十二指肠动脉瘤(未破裂,1例;破裂,2例),两例是在肝胆胰手术之前,还有一例是无症状病例。在所有病例中,都按照上述方法进行了腹腔镜-MALR,并成功解除了CA狭窄。我们的病例系列证明了腹腔镜-MALR术在治疗MALS相关疾病(包括与CA压迫相关的胰十二指肠动脉瘤)方面的安全性和可靠性。
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来源期刊
Annals of Gastroenterological Surgery
Annals of Gastroenterological Surgery GASTROENTEROLOGY & HEPATOLOGY-
CiteScore
5.30
自引率
11.10%
发文量
98
审稿时长
11 weeks
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