Journal of Visceral Surgery (2018) 155, 159—161 Available online at ScienceDirect www.sciencedirect.com VISCERAL SURGERY VIDEOS Laparoscopic approach to median arcuate ligament syndrome (with video) S. Landen a,b,* , T. Ballet a , V. Delugeau c , C. Landen d a CHIREC Hospitals, Brussels, Belgium b Cliniques Universitaires St Luc, Brussels, Belgium c Groupe hospitalier Epsylon, Brussels, Belgium d Louvain University faculty of medicine, Brussels, Belgium Available online 17 April 2018 KEYWORDS Median arcuate ligament syndrome; Celiac artery compression syndrome; Dunbar syndrome; Celiac artery stenosis; Laparoscopy Compression of the celiac artery by the median arcuate ligament is a common finding on imaging studies but is clinically significant in a minority of patients only. Symptoms are aspecific and include postprandial epigastric pain and weight loss. Pain can be constant or caused by exercise and may be associated with nausea, vomiting, bloating or diarrhea. Common causes associated with dyspepsia should always be excluded before incriminating a median arcuate ligament [1]. Surgical sectioning of the median arcuate ligament is the primary management of this syndrome and can be followed by percutaneous angioplasty and/or surgical revascularisation in case of failure [1]. Underlying mechanisms of abdom- inal pain remain uncertain and may be due to splanchnic ischemia or neuralgia secondary to celiac plexus compression. However, some patients who improve their symptoms after surgery continue to have a celiac axis stenosis on postoperative angiograms. Preopera- tive celiac plexus block using local anesthetic may also be predictive for postoperative improvement after surgery [2]. This video shows the surgical sectioning of a median arcu- ate ligament using a laparoscopic approach. Main steps of this procedure include incision of the gastro-hepatic ligament and lateral retraction of the lesser curve of the stomach, incision of the peritoneum overlying the caudal portion of the right crux (Fig. 1), sepa- ration of the diaphragmatic cruces to expose the abdominal aorta cranial to the celiac axis (Fig. 2), and taping of the left gastric vessels that are retracted ventrally and to the right. The neck of the pancreas is retracted caudally and the dissection follows the left gastric artery and celiac axis to its origin on the aorta, carefully transecting all muscular, fibrous and nervous tissues overlying the artery (Figs. 3—5). The initial field of dissection * Corresponding author at: CHIREC Hospital Group, blvd du Triomphe 201, 1160 Brussels, Belgium. E-mail address: landenserge@gmail.com (S. Landen). https://doi.org/10.1016/j.jviscsurg.2017.12.014 1878-7886/© 2017 Elsevier Masson SAS. All rights reserved.