Decompression surgery of the celiac trunc - a single center experience

Background Abdominal pain from extrinsic compression of the celiac trunk, by a fibrous diaphragmatic arcuatum ligament is commonly referred to as Median Arcuate Ligament Syndrom (MALS). This rare condition requires a detailed preoperative workup and a customized minimally invasive treatment strategy. Celiac trunc decompression, furthermore plays a key role in patients undergoing liver transplantation.

Material and methods We reviewed our institutional database for patients with MALS as well as liver transplant candidates which also required a celiac trunc decompression during the transplant procedure.

Results Between 2016 and 2019, fourteen patients were diagnosed with MALS. Mean patient age was 51±19 years, and MALS was predominantly present in women (n=9, 64%). Two patients received laparoscopic decompression surgery; six patients qualified for a conservative follow up due to mild symptoms and another 6 patients refused a surgical intervention. Mean operative time was 50±6. No abdominal drains were placed. MAL associated symptoms resolved in all treated patients. Morbidity was 0%. Patients were discharged on postoperative day 3. In 2019, n=32 liver transplants were performed at our institution. Four patients (12.5%) required celiac trunc decompression during the transplant procedure to reestablish sufficient blood flow (233±25ml/min) through the hepatic artery. Decompression surgery related morbidity was 0%. Overall morbidity was 18.75% (n=6) and 60-day mortality was 3.2% (n=1).

Discussion Decompression surgery for the celiac trunc is necessary in patienets with MALS and asymptomatic patients undergoing liver transplantation. Both minimally invasive and open decompression strategies are feasible and save. General diagnostic and therapeutic guidelines are in need.

Publication History

Article published online:
08 September 2020