Home About us Editorial board Ahead of print Current issue Search Archives Submit article Instructions Subscribe Contacts LOGIN
  • Users Online:161
  • Home
  • Print this page
  • Email this page
ORIGINAL ARTICLE
Year : 2021  |  Volume : 6  |  Issue : 1  |  Page : 12-16

Addition of antireflux procedure to median arcuate ligament release: A significant difference?


Department of Surgical Gastroenterology, Lifeline Institute of Minimal Access, Chennai, Tamil Nadu, India

Correspondence Address:
Dr. Jayakrishna Reddy Aluru
Lifeline Institute of Minimal Access, No. 47/3 New Avadi Road, Kilpauk, Chennai - 600 010, Tamil Nadu
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/sjl.sjl_11_20

Rights and Permissions

Introduction: Median arcuate ligament syndrome (MALS) is a rare but debilitating gastrointestinal disorder. Division of the ligament (obstructing flow to the celiac artery) cures the symptoms, and a celiac ganglionectomy is also performed. Retroesophageal dissection causes dilatation of the hiatus. Severe gastroesophageal reflux disease (GERD) in the first six patients (Group A) led us to add an antireflux procedure in (Group B) 18 patients. Manometric and 24 h pH data support this. This article has been reported in line with SQUIRE guidelines. Materials and Methods: Over 7 years, we encountered 24 patients with MALS. The diagnosis was clinched by CT angiography, by the characteristic “Hook sign”. We have devised a standard operating strategy, involving retroesophageal mobilization, diaphragmatic crural exposure dividing the MAL, clearing out the perivascular neural tissue around the celiac axis, and exposing the celiac artery origin and its branches. The procedure was completed by crural approximation; Toupet fundoplication was performed in Group B patients. Relief from MALS symptomatology was obtained in all patients. Group A patients had severe reflux. Results: All patients were pain free within the 1st month of follow-up and regained normal weight by 6 months. Postoperative reflux symptoms initially were seen in four patients in Group B and all six patients in Group A. By the 6th month postprocedure, all Group B patients were symptom free and all Group A patients had persistent GERD. Conclusion: To our knowledge, there is no reported series in English literature with a formal protocol for MALS. Our approach provides an efficacious solution to a debilitating disorder. The addition of fundoplication has shown significant improvement in reflux symptoms.


[FULL TEXT] [PDF]*
Print this article     Email this article
 Next article
 Previous article
 Table of Contents

 Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
 Citation Manager
 Access Statistics
 Reader Comments
 Email Alert *
 Add to My List *
 * Requires registration (Free)
 

 Article Access Statistics
    Viewed748    
    Printed60    
    Emailed0    
    PDF Downloaded22    
    Comments [Add]    

Recommend this journal