Laparoskopische Spaltung des Lig. arcuatum: die Behandlung des Truncus-coeliacus-Kompressionssyndroms

Zusammenfassung

Zielsetzung: Das Truncus-coeliacus-Kompressionssyndrom, das zuerst durch Harjola und Dunbar beschrieben wurde, resultiert aus der Einengung des Truncus und Plexus coeliacus an ihrem Ursprung durch das Lig. arcuatum. Die in ihrer Lebensqualität stark eingeschränkten Patienten klagen über postprandiale Schmerzen und Gewichtsverlust. Selten ist ein epigastrisches Strömungsgeräusch in der klinischen Untersuchung nachzuweisen. Durch laparoskopische Spaltung des Lig. arcuatum kann das Truncus-coeliacus-Syndrom erfolgreich therapiert werden.

Indikation: Nachgewiesene Kompression des Truncus coeliacus (Duplexsonografie, CT-Angiografie oder MR-Angiografie) bei Patienten mit der Symptomtrias aus postprandialen Schmerzen, Gewichtsverlust und epigastrischem Strömungsgeräusch.

Methode: Laparoskopische Spaltung des Lig. arcuatum nach dessen Darstellung oberhalb des Ursprungs des Truncus coeliacus aus der Aorta abdominalis.

Schlussfolgerung: Die laparoskopische Spaltung des Lig. arcuatum und die Durchtrennung der Plexus-coeliacus-Äste stellt eine komplikationsarme, die Lebensqualität wiederherstellende minimalinvasive Option zur Behandlung des Truncus-coeliacus-Kompressionssyndroms dar.

Abstract

Objective: The coeliac artery compression syndrome, first described by Harjola und Dunbar, results from the coeliac artery and plexus being compressed by the arcuate ligament at their origin. The clinical symptoms are postprandial pain and weight loss and the syndrome significantly restricts patientsʼ quality of life. In rare cases, an epigastric bruit is detected on clinical examination. Laparoscopic division of the arcuate ligament is a successful option for the treatment of the coeliac artery compression syndrome.

Indications: Laparoscopic decompression is indicated for patients with a symptom triad of postprandial pain, weight loss and epigastric bruit and radiologic confirmation of coeliac artery compression by duplex sonography, computed tomography angiography or magnetic resonance angiography.

Procedure: The operative strategy is based on the division of the arcuate ligament following its visualisation above the origin of the coeliac artery from the abdominal aorta.

Conclusion: The laparoscopic division of the arcuate ligament and the resection of the coeliac plexus are a largely uneventful, minimally-invasive option to treat the coeliac artery compression syndrome and restore patientsʼ quality of life.

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