Dunbar syndrome – single-center experience with surgical treatment

Abstract

Introduction: Dunbar syndrome is caused by compression of the truncus coeliacus (TC), most commonly by the median arcuate ligament. Chronic irritation of the TC during breathing leads to fibrous changes of the arterial wall and formation of fixed stenosis. This compression syndrome is often associated with specific complaints including weight loss and early postprandial epigastric pain. In this study, we summarize our experience with a group of 14 patients from a single institution.
Methods: In 14 patients who were diagnosed with Dunbar syndrome and who were referred for surgery, we performed an invasive measurement of systemic pressure in a. radialis during the operation and compared it with invasively measured pressure in a. gastrica sinistra before and after the release of TC. In patients with significant stenosis (pressure gradient above 15 mmHg), a bypass was performed.
Results: The initial pressure gradient of 56±19 mmHg decreased after the release of TC to 39±16 mmHg (p<0.0001). In 13 (93%) patients with a persisting elevated gradient (above 15 mmHg) this decreased by 5±3 (p<0.0001) after subsequent bypass surgery. All patients experienced a clinical improvement, and one year after the operation their symptoms disappeared altogether. During the follow-up, we did not record any complications or the need to perform an additional procedure.
Conclusion: Surgical treatment of Dunbar syndrome is a safe modality with satisfactory long-term results. We believe that it is always convenient to assess how successful the release of TC was and, in the case of a significant residual stenosis, to consider further steps – in our case bypassing the stenotic segment.