Laparoscopic Surgery in Chronic Mesenteric Ischemia: Release of the Superior Mesenteric Artery from the Median Arcuate Ligament Using the Transperitoneal Left Retrorenal Approach.

Median arcuate ligament (MAL) syndrome usually involves the celiac artery (CA) only. Far less frequently, both the CA and superior mesenteric artery (SMA) are compressed, leading to chronic mesenteric ischemia. We report the case of a 46-year-old woman with a 4-year history of permanent nausea, postprandial abdominal pain, and asthenia. A clear epigastric bruit was observed on physical examination. Duplex ultrasound and computed tomography angiography revealed an occlusion of the CA and a highly compressed proximal SMA by the MAL, with an important collateral mesenteric network. Laparoscopic release of the MAL using a transperitoneal retrorenal approach was performed, with excellent postoperative outcomes. Compression of the SMA by the MAL is a rare cause of chronic mesenteric ischemia. Laparoscopic release of the SMA from the MAL using a transperitoneal retrorenal approach is safe and effective. Long-term outcomes need to be further assessed.