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CIRCLING THE ENEMY: RECURRENT MEDIAN ARCUATE LIGAMENT SYNDROME WITH INFRAPANCREATIC CELIAC TRUNK
Clara Kit Nam Lai^*, AJ Haas, Ramiro Cadena Semanate, Alejandro Feria, Jamie DeCicco, Amelia Dorsey, Sergio Bardaro, Kevin El-Hayek
General Surgery, MetroHealth Medical Center, Cleveland, OH

Reoperative median arcuate ligament (MAL) release is a technically challenging procedure. We present a case of a 27-year-old female who previously underwent laparoscopic MAL release with recurrent symptoms a few weeks after surgery. A preoperative CTA showed persistent celiac trunk compression from the MAL with an infrapancreatic portion of the celiac trunk. The patient underwent robotic-assisted reoperative MAL release with celiac lymphadenectomy and ganglionectomy. This video highlights the necessity of an infrapancreatic approach given the unique anatomy, and the use of intraoperative ultrasound and fluorescence angiography to evaluate for adequate release.

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