"Step-by-step" principles of safe laparoscopic approach with technical details in "median arcuate ligament syndrome"

The median arcuate ligament syndrome (MALS) is a rare cause of postprandial pain and weight loss. The median arcuate ligament (MAL) is a fibrous band of the diaphragmatic crura. Abnormally downward located MAL or high take off of the celiac artery result in external compression the celiac trunk. MAL narrows the truncus coeliacus even more clearly during the expiration. The chronic compression of the celiac artery reduces blood flow and causes symptoms. Symptomatic patients receive surgical treatment, in recent years, an increasing rate, especially laparoscopic. The rate of conversion to open surgery is 10.3% due to vascular injury in hemorrhage, which generally occurs during dissection. A maneuver is needed to continue with the surgical procedure safely here because of the close neighboring of the aorta, truncus coeliacus, and one of its branches. Technical standardization can reduce the complication rate. There is still no standardized and established laparoscopic method in the world. There are no randomized controlled studies in the literature, which show the superiority of these techniques over one another. The maneuver in this case report, through traction with a tape towards caudal, allows a brilliant view on the celiac axis with shortened operation time. It also makes the operation even safer because of its enabling mastery over the celiac artery and easy dissection.