Clinical outcomes after surgical decompression of median arcuate ligament syndrome-An observational study

Kenji Matsumoto; Hiroharu Shinozaki; Satoshi Shinozaki; Seigo Yukisawa; Masaru Kimata; Toshiaki Terauchi; Naohiro Sata

doi:10.1007/s12664-024-01560-y

Clinical outcomes after surgical decompression of median arcuate ligament syndrome-An observational study

Indian J Gastroenterol. 2024 May 11. doi: 10.1007/s12664-024-01560-y. Online ahead of print.

Authors

Kenji Matsumoto^{1

2}, Hiroharu Shinozaki¹, Satoshi Shinozaki^{3

4}, Seigo Yukisawa¹, Masaru Kimata¹, Toshiaki Terauchi¹, Naohiro Sata²

Affiliations

¹ Department of Surgery, Saiseikai Utsunomiya Hospital, Utsunomiya, Japan.
² Department of Surgery, Jichi Medical University, Shimotsuke, Japan.
³ Shinozaki Medical Clinic, 6-1-13 Kiyoharadai, Utsunomiya, Tochigi, 321-3223, Japan. shinozaki-s@aqua.ocn.ne.jp.
⁴ Division of Gastroenterology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan. shinozaki-s@aqua.ocn.ne.jp.

PMID: 38733498
DOI: 10.1007/s12664-024-01560-y

Abstract

Background and objectives: Median arcuate ligament syndrome is caused by compression and stenosis of the celiac artery. Incision of the median arcuate ligament improves persistent abdominal symptoms. The study aimed at evaluating the outcomes in patients who underwent median arcuate ligament syndrome decompression using a self-report questionnaire.

Methods: This single-center retrospective study included patients with median arcuate ligament syndrome who underwent decompression surgery between April 2021 and February 2023. The medical records were retrospectively reviewed.

Results: Ten patients were included in the study. Laparotomy and laparoscopic surgeries were performed in seven and three patients, respectively. The median operation time was 147 minutes. The median hospitalization period after the operation was seven days. The degrees of celiac artery stenosis before and after surgery were compared and the per cent diameter stenosis did not significantly improve; five of 10 patients (50%) had > 50% stenosis in the celiac artery after the operation. Compared to the baseline, the scores of upper gastrointestinal symptoms significantly improved during the six months' period (p < 0.001). Additionally, we evaluated the influence of post-operative per cent diameter stenosis and divided the patients into two groups (≥ 50% vs, < 50%). The scores of upper gastrointestinal (GI) symptoms in both groups improved significantly from baseline. However, the symptomatic improvement at six months in the post-operative per cent diameter stenosis < 50% group was significantly greater than that in the ≥ 50% group (p = 0.016). The scores of lower gastrointestinal symptoms did not change significantly during the six-month period.

Conclusion: Decompression surgery for median arcuate ligament syndrome could improve upper gastrointestinal symptoms regardless of the post-operative per cent diameter stenosis.

Keywords: Aneurysm; Celiac artery; Celiac axis; Decompression; Gastrointestinal diseases; Hepatic artery; Median arcuate ligament syndrome; Self-report; Treatment outcome; Ultrasonography.