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Background <p>Median arcuate ligament syndrome (MALS) and superior mesenteric artery syndrome (SMAS) are rare vascular and mechanical compression syndromes, respectively. Their coexistence is extremely uncommon, and no standardized surgical approach has been established for patients presenting with both conditions. This study aims to evaluate the safety and efficacy of simultaneous laparoscopic median arcuate ligament release (LMALR) and duodenojejunostomy in patients diagnosed with both MALS and SMAS.</p> Methods <p>Between July 2022 and November 2024, a&#xa0;total of 13&#xa0;patients diagnosed with MALS and with concurrent SMAS findings were evaluated. Patients were classified into three groups based on symptom presentation and imaging findings, with 8&#xa0;patients from group&#xa0;1 and group&#xa0;2&#xa0;undergoing simultaneous LMALR and duodenojejunostomy. Preoperative, intraoperative, and postoperative data were analyzed, including vascular parameters (celiac artery stenosis, peak systolic velocity), weight changes, symptom resolution, and surgical outcomes.</p> Results <p>Postoperative abdominal CT angiography demonstrated that the celiac artery narrowing had resolved, and peak systolic velocities had returned to normal in all patients. The simultaneous laparoscopic approach demonstrated a&#xa0;100% technical success rate, as evidenced by improved vascular and nutritional parameters. No major complications, anastomotic leaks, or mortality were observed.</p> Conclusion <p>This study represents the first case series reporting simultaneous laparoscopic LMALR and duodenojejunostomy for MALS and SMAS. Additionally, it introduces a&#xa0;novel classification system to guide surgical decision-making. Our findings suggest that simultaneous laparoscopic correction is safe, effective, and beneficial in selected patients, reducing the need for secondary procedures. Further prospective studies are needed to establish standardized treatment guidelines.</p>

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Simultaneous laparoscopic median arcuate ligament release and duodenojejunostomy for treatment of concurrent MALS and SMAS: a novel classification and surgical approach

  • 期刊论文

  • 发表日期：

    2025年5月22日

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  • Fahri Yetişir,
  • Şükrü Tekindur,
  • Yasin Akın,
  • Ömer Kurt,
  • Ramazan Tiken,
  • Muhammet Emin Çelik

摘要

Background

Median arcuate ligament syndrome (MALS) and superior mesenteric artery syndrome (SMAS) are rare vascular and mechanical compression syndromes, respectively. Their coexistence is extremely uncommon, and no standardized surgical approach has been established for patients presenting with both conditions. This study aims to evaluate the safety and efficacy of simultaneous laparoscopic median arcuate ligament release (LMALR) and duodenojejunostomy in patients diagnosed with both MALS and SMAS.

Methods

Between July 2022 and November 2024, a total of 13 patients diagnosed with MALS and with concurrent SMAS findings were evaluated. Patients were classified into three groups based on symptom presentation and imaging findings, with 8 patients from group 1 and group 2 undergoing simultaneous LMALR and duodenojejunostomy. Preoperative, intraoperative, and postoperative data were analyzed, including vascular parameters (celiac artery stenosis, peak systolic velocity), weight changes, symptom resolution, and surgical outcomes.

Results

Postoperative abdominal CT angiography demonstrated that the celiac artery narrowing had resolved, and peak systolic velocities had returned to normal in all patients. The simultaneous laparoscopic approach demonstrated a 100% technical success rate, as evidenced by improved vascular and nutritional parameters. No major complications, anastomotic leaks, or mortality were observed.

Conclusion

This study represents the first case series reporting simultaneous laparoscopic LMALR and duodenojejunostomy for MALS and SMAS. Additionally, it introduces a novel classification system to guide surgical decision-making. Our findings suggest that simultaneous laparoscopic correction is safe, effective, and beneficial in selected patients, reducing the need for secondary procedures. Further prospective studies are needed to establish standardized treatment guidelines.