Laparoscopic procedure of celiac artery compression syndrome in children

Background. The celiac artery (CA) compression syndrome (CACS) is a rarely diagnosed disorder, which is characterized by chronic abdominal pain and vegetative symptoms. The role of surgical treatment in CA decompression has been discussed controversially by numerous authors. Patients and methods. Three patients (median age, 15 years) diagnosed with CACS underwent laparoscopic decompression. The patients presented with chronic abdominal pain, vegetative symptoms and a reduced quality of life. Doppler sonography showed an increased blood flow velocity of the CA with maximum of 190-300 cm/s (mean 205 cm/s). CT angiography and angiography demonstrated a characteristic hook-shaped appearance of the CA with severe localized compression. Results. All patients underwent laparoscopic decompression of the CA. Four or five ports we used during laparoscopic approach. The procedure consisted of division of the median arcuate ligament and complete mobilization of the CA from its origin on the aorta to its trifurcation. Average operating time was 65 minutes, and the average length of stay was 4 days. We did not observe any complications. Postoperatively all patients were immediately free of abdominal pain. Doppler sonography showed a marked reduction in CA blood flow velocity. Anincrease of vessel diameters to normal dimensions was documented by postoperative CT angiography. Conclusions. Laparoscopic treatment of celiac artery compression syndrome offers a novel, safe, reliable and, compared to open surgery, less invasive approach. The surgical treatment is indicated in patients with characteristic symptoms and typical findings at Doppler sonography and CT after exclusion of other abdominal pathologies