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

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.