Li SX, Fan YH, Tian GY, Lv GY. Feasible management of median arcuate ligament syndrome in orthotopic liver transplantation recipients. World J Gastrointest Surg 2022; 14(9): 976-985 [PMID: 36185558 DOI: 10.4240/wjgs.v14.i9.976]
Corresponding Author of This Article
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
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
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 bythe 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.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
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
Abstract
BACKGROUND
In orthotopic liver transplantation (OLT) recipients, median arcuate ligament syndrome (MALS) is considered a risk factor for hepatic arterial thrombosis (HAT), which is dreadful for OLT recipients. Different alternative surgical procedures have been proposed to overcome the impact of MALS on transplantation, but clinical evidence is still scarce.
AIM
To evaluate the feasible surgical management of MALS to reduce complications in OLT patients.
METHODS
Data for 288 consecutive patients who underwent OLT at The First Hospital of Jilin University between January 2017 and July 2020 were retrospectively reviewed. The surgical management of median arcuate ligament (MAL) and modifications to the arterial anastomosis were recorded. The perioperative and long-term prognosis of MALS recipients were noted. Detailed preoperative and postoperative data of patients were analyzed in a descriptive manner.
RESULTS
Eight patients with MALS were included in this study. The first patient with MALS received no intervention during the primary surgery and developed postoperative HAT. Salvage liver transplantation with MAL division was successfully performed. Gastroduodenal artery (GDA) preservation with splenic artery ligation was performed on three patients, only GDA preservation was performed on two patients, and no intervention was performed on two patients. No patient developed HAT after surgery and postoperative recovery was satisfactory.
CONCLUSION
The preservation of collateral circulation between the superior mesenteric artery and celiac trunk via the GDA with or without splenic artery ligation is a safe and feasible alternative to MAL division.
Core Tip: This retrospective single-center study analyzed diagnosis, surgical procedure and outcome of 8 patients with median arcuate ligament syndrome (MALS). In eight patients with MALS, orthotopic liver transplantation without median arcuate ligament (MAL) division and celiac trunk-aorta bypass ensured adequate hepatic arterial blood flow. No new onset hepatic arterial thrombosis was observed. The study suggests that without intraoperative MAL release, one cannot ensure adequate hepatic artery flow and prevent hepatic arterial thrombosis.
