Laparoscopic decompression of the celiac trunk: tactical and technical aspects

Abstract

Introduction. Currently, traditional methods and minimally invasive surgical technologies are used in the treatment of celiac trunk compression syndrome. The choice of treatment method remains a subject of discussion. The drawback of the classical approach – laparotomy – is a significant trauma to the tissues of the abdominal wall, the risk of adhesions, wound infection and hernias. The disadvantage of videosurgical techniques is the risk of developing life-threatening bleeding requiring conversion of access. The main cause of this complication is damage to the wall of the aorta, celiac trunk and its branches during the intervention.Methods and materials. A set of tactical and technical principles was developed to reduce the risk of bleeding during laparoscopic decompression of the celiac trunk. The prerequisites were an assessment of the individual architectonics of the vessels according to 3D reconstruction data, the location of working instruments as parallel to the celiac trunk course, retrograde access to the compression zone, the use of an ultrasonic or bipolar dissector, contact with the vascular wall only with passive branches. With these principles surgical intervention was performed in 12 patients.Results. Complication (bleeding from the branch of the lower phrenic artery) – occurred in one (8.3 %) case – was eliminated laparoscopically. The average duration of the operation was 85 minutes, the average hospital day after the operation was 5 days. Treatment results within 3 to 12 months were evaluated in 8 out of 12 (66.7 %) patients. In 7 (87.5 % of patients with the studied results) cases, complete regression of symptoms and restoration of normal blood flow were noted. One (12.5 %) person had a slight abdominal pain syndrome against the background of normal hemodynamics in the celiac trunk.Conclusion. The presented data are comparable with the results of traditional surgical methods of treatment of celiac trunk compression syndrome and are the basis for further research.