Feasible management of median arcuate ligament syndrome in orthotopic liver transplantation recipients

doi:10.4240/wjgs.v14.i9.976

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World Journal of Gastrointestinal Surgery

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World J Gastrointest Surg. Sep 27, 2022; 14(9): 976-985
Published online Sep 27, 2022. doi: 10.4240/wjgs.v14.i9.976

Feasible management of median arcuate ligament syndrome in orthotopic liver transplantation recipients

Shu-Xuan Li, Ye-Hui Fan, Guang-Yao Tian, Guo-Yue Lv

Shu-Xuan Li, Guang-Yao Tian, Guo-Yue Lv, Department of Hepatobiliary and Pancreatic Surgery, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China

Ye-Hui Fan, Department of The First Operation Room, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China

Author contributions: Li SX and Fan YH contributed equally to this work; Li SX wrote the original draft of the manuscript; Fan YH was responsible for the revision and editing of the manuscript; Tian GY was responsible for data curation and software; LV GY was responsible for supervision and methodology; All authors issued final approval for the version submitted.

Supported by the Science and Technology Department of Jilin Province, No. 20190101002JH.

Institutional review board statement: This research was approved by the Ethical Committee of First Hospital of Jilin University.

Informed consent statement: The patients provided informed written consent.

Conflict-of-interest statement: The authors have no conflicts of interest to disclose.

Data sharing statement: Dataset is available from the corresponding author at lvgy@jlu.edu.cn. Participants gave informed consent for data sharing.

Corresponding author: Guo-Yue Lv, PhD, Dean, Professor, Surgeon, Department of Hepatobiliary and Pancreatic Surgery, The First Hospital of Jilin University, No. 1 Xinmin Street, Changchun 130021, Jilin Province, China. lvgy@jlu.edu.cn

Received: June 6, 2022
Peer-review started: June 6, 2022
First decision: July 12, 2022
Revised: July 22, 2022
Accepted: August 25, 2022
Article in press: August 25, 2022
Published online: September 27, 2022
Processing time: 108 Days and 9.1 Hours

ARTICLE HIGHLIGHTS

Research background

In orthotopic liver transplantation (OLT) recipients, median arcuate ligament syndrome (MALS) is regarded as a risk factor for hepatic artery thrombosis (HAT), a devastating complication of OLT. To counteract the influence of MALS on transplantation, a variety of different surgical methods have been proposed, but clinical evidence is still lacking.

Research motivation

To increase the survival rate of MALS patients who receive OLT and decrease postoperative complications.

Research objectives

To evaluate the efficacy of surgical treatment for MALS to reduce complications in OLT patients in order to improve patient survival and decrease the incidence of postoperative complications.

Research methods

A total of 288 consecutive OLT patients at The First Hospital of Jilin University were retrospectively evaluated. Median arcuate ligament (MAL) surgical treatment and arterial anastomosis modification were recorded. Perioperative and long-term MALS prognoses were noted.

Research results

In this investigation, eight patients with MALS were enrolled. The first patient with MALS did not get any intervention during the main operation, and afterward developed HAT. Successful salvage liver transplantation with MAL division was accomplished. Gastroduodenal artery (GDA) preservation with splenic artery ligation was performed on three patients, GDA preservation alone was performed on two patients, and no intervention were performed on two patients. After surgery, no patient got HAT and healing was acceptable.

Research conclusions

The preservation of collateral circulation between the superior mesenteric artery and celiac trunk via the GDA, with or without ligation of the splenic artery, provides a safe and practicable alternative to MAL division.

Research perspectives

To provide surgeons with effective and feasible surgical options when they need to perform OLT in MALS patients.