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ISSN: 1895-4588
Videosurgery and Other Miniinvasive Techniques
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4/2016
vol. 11
 
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abstract:
Original paper

Hybrid (laparoscopy + stent) treatment of celiac trunk compression syndrome (Dunbar syndrome, median arcuate ligament syndrome (MALS))

Maciej Michalik
,
Natalia Dowgiałło-Wnukiewicz
,
Paweł Lech
,
Kaja Majda
,
Piotr Gutowski

Videosurgery Miniinv 2016; 11 (4): 236–239
DOI: https://doi.org/10.5114/wiitm.2016.64070
Online publish date: 2016/12/02
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Introduction: Celiac trunk (CT) compression syndrome caused by the median arcuate ligament (MAL) is a rarely diagnosed disease because of its nonspecific symptoms, which cause a delay in the correct diagnosis. Intestinal ischemia occurs, which causes symptoms of abdominal angina. One method of treatment for this disease is surgical release of the CT – the intersection of the MAL. Laparoscopy is the first step of the hybrid technique combined with percutaneous angioplasty and stenting of the CT.

Aim: To demonstrate the usefulness and advantages of the laparoscopic approach in the treatment of Dunbar syndrome.

Material and methods: Between 2013 and 2016 in the General and Minimally Invasive Surgery Department of the Medical Sciences Faculty of the University of Warmia and Mazury in Olsztyn, 6 laparoscopic procedures were performed because of median arcuate ligament syndrome. During the laparoscopy the MAL was cut with a harmonic scalpel. One month after laparoscopy 5 patients had Doppler percutaneous angioplasty of the CT with stent implantation in the Vascular Surgery Department in Pomeranian Medical University in Szczecin.

Results: In one case, there was a conversion of laparoscopic surgery to open due to unmanageable intraoperative bleeding. In one case, postoperative ultrasound examination of the abdominal cavity demonstrated the presence of a large hematoma in the retroperitoneal space. All patients reported relief of symptoms in the first days after the operation.

Conclusions: The hybrid method, combining laparoscopy and angioplasty, seems to be a long-term solution, which increases the comfort of the patient, brings the opportunity for normal functioning and minimizes the risk of restenosis.
keywords:

laparoscopy, hybrid technique, median arcuate ligament syndrome, Dunbar syndrome, stent implantation
  
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