title: Hybrid (laparoscopy + stent) treatment of celiac trunk compression syndrome (Dunbar syndrome, median arcuate ligament syndrome (MALS)).
abstract: BACKGROUND
  Celiac trunk (CT) compression syndrome caused by the median arcuate ligament (MAL) is a rarely diagnosed disease because of its nonspecific symptoms, which cause a delay in the correct diagnosis. Intestinal ischemia occurs, which causes symptoms of abdominal angina. One method of treatment for this disease is surgical release of the CT - the intersection of the MAL. Laparoscopy is the first step of the hybrid technique combined with percutaneous angioplasty and stenting of the CT.
  
  
  OBJECTIVE
  To demonstrate the usefulness and advantages of the laparoscopic approach in the treatment of Dunbar syndrome.
  
  
  METHODS
  Between 2013 and 2016 in the General and Minimally Invasive Surgery Department of the Medical Sciences Faculty of the University of Warmia and Mazury in Olsztyn, 6 laparoscopic procedures were performed because of median arcuate ligament syndrome. During the laparoscopy the MAL was cut with a harmonic scalpel. One month after laparoscopy 5 patients had Doppler percutaneous angioplasty of the CT with stent implantation in the Vascular Surgery Department in Pomeranian Medical University in Szczecin.
  
  
  RESULTS
  In one case, there was a conversion of laparoscopic surgery to open due to unmanageable intraoperative bleeding. In one case, postoperative ultrasound examination of the abdominal cavity demonstrated the presence of a large hematoma in the retroperitoneal space. All patients reported relief of symptoms in the first days after the operation.
  
  
  CONCLUSIONS
  The hybrid method, combining laparoscopy and angioplasty, seems to be a long-term solution, which increases the comfort of the patient, brings the opportunity for normal functioning and minimizes the risk of restenosis.
authors.affiliation: Department of General and Minimally Invasive Surgery, University of Warmia and Mazury, Olsztyn, Poland.
authors.forename: Maciej
authors.initials: M
authors.lastname: Michalik
authors.affiliation: Department of General and Minimally Invasive Surgery, University of Warmia and Mazury, Olsztyn, Poland; Department of Anatomy, University of Warmia and Mazury, Olsztyn, Poland.
authors.forename: Natalia
authors.initials: N
authors.lastname: Dowgiałło-Wnukiewicz
authors.affiliation: Department of General and Minimally Invasive Surgery, University of Warmia and Mazury, Olsztyn, Poland.
authors.forename: Paweł
authors.initials: P
authors.lastname: Lech
authors.affiliation: Department of General and Minimally Invasive Surgery, University of Warmia and Mazury, Olsztyn, Poland.
authors.forename: Kaja
authors.initials: K
authors.lastname: Majda
authors.affiliation: Department of Vascular Surgery, Pomeranian Medical University, Szczecin, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Gutowski
keywords: Dunbar syndrome; hybrid technique; laparoscopy; median arcuate ligament syndrome; stent implantation