Perils with Laparoscopic Surgery for Median Arcuate Ligament Syndrome

Abstract

A 64 years, ASA 1 male patient with median arcuate ligament syndrome was posted for laparoscopic release of coeliac artery compression. The median arcuate ligament is a fibrous arch that unites the diaphragmatic crura on either side of the aortic hiatus. The ligament usually passes superior to the origin of the celiac artery near the first lumbar vertebra. . Infrequently, when this union occurs anterior to celiac axis it may cause hemodynamically significant stenosis compressing the vessel and nerves leading to median arcute ligament (MALS).The surgery of median arcuate ligament release for coeliac artery decompression involved working in the proximity of major vessels. Anticipation of major blood loss should be kept in mind that may be may be further compounded by the disease process in the vessels which make repair of vessels more difficult.Iatrogenic aortic injury happened in our case which was succesfully managed. Timely involvement of cardiovascular surgeons is important therefore the case has to be discussed with them prior proceeding for surgery. Hypothermia, hemorrhagic shock, coagulopathy, hypoxia, acidosis,pre-renal failure can be prevented with thorough preparation and timely intervention.