TY - JOUR
T1 - Laparoscopic Median Arcuate Ligament Release
T2 - Surgical Technique and Clinical Outcomes
AU - Belluzzi, Amanda
AU - Salame, Marita
AU - Mosleh, Kamal Abi
AU - Rasmussen, Todd E.
AU - Kendrick, Michael L.
AU - Ghanem, Omar M.
N1 - Publisher Copyright:
Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2024/2/27
Y1 - 2024/2/27
N2 - Background: Median arcuate ligament syndrome (MALS) is characterized by a constellation of symptoms related to the compression of the celiac artery trunk. Laparoscopic release of the ligament has demonstrated its effectiveness in alleviating these symptoms while showing lower postoperative complication rates, reduced hospital stays, and improved clinical outcomes. This study describes a single institution’s experience with this procedure and reports on the preoperative assessment, surgical technique, and clinical outcomes of patients with MALS. Methods: We performed a retrospective chart review of all patients who underwent a primary laparoscopic MAL release (MALR) at a single high-volume academic institution from June 2021 to July 2023. Patient demographics, preoperative assessment, postoperative complications, and resolution of preoperative symptoms data were collected. Results: A total of 30 patients underwent laparoscopic MALR, with 76.7% being female and a mean age of 33.4 ± 16.3 years. The most common presenting symptom was postprandial epigastric pain (100%), followed by abdominal pain and nausea (83.3%), among others. The preoperative evaluation for all patients included a duplex mesenteric doppler and CT angiogram during inspiration and expiration and 3D reconstruction. Successful laparoscopic decompression of the celiac artery was achieved in 96.6% of cases, with only one conversion to an open procedure. There was only one reported early (< 30 d postoperatively) complication with no subsequent late complications or mortality. None of the patients required reintervention or reoperation. Only 1 patient required postoperative celiac plexus/ splanchnic block injection to alleviate pain. Conclusions: MALS can be effectively and safely managed using a laparoscopic approach when performed by an experienced minimally invasive surgeon. Further studies with longer follow-ups are needed to confirm the long-term effectiveness of this technique.
AB - Background: Median arcuate ligament syndrome (MALS) is characterized by a constellation of symptoms related to the compression of the celiac artery trunk. Laparoscopic release of the ligament has demonstrated its effectiveness in alleviating these symptoms while showing lower postoperative complication rates, reduced hospital stays, and improved clinical outcomes. This study describes a single institution’s experience with this procedure and reports on the preoperative assessment, surgical technique, and clinical outcomes of patients with MALS. Methods: We performed a retrospective chart review of all patients who underwent a primary laparoscopic MAL release (MALR) at a single high-volume academic institution from June 2021 to July 2023. Patient demographics, preoperative assessment, postoperative complications, and resolution of preoperative symptoms data were collected. Results: A total of 30 patients underwent laparoscopic MALR, with 76.7% being female and a mean age of 33.4 ± 16.3 years. The most common presenting symptom was postprandial epigastric pain (100%), followed by abdominal pain and nausea (83.3%), among others. The preoperative evaluation for all patients included a duplex mesenteric doppler and CT angiogram during inspiration and expiration and 3D reconstruction. Successful laparoscopic decompression of the celiac artery was achieved in 96.6% of cases, with only one conversion to an open procedure. There was only one reported early (< 30 d postoperatively) complication with no subsequent late complications or mortality. None of the patients required reintervention or reoperation. Only 1 patient required postoperative celiac plexus/ splanchnic block injection to alleviate pain. Conclusions: MALS can be effectively and safely managed using a laparoscopic approach when performed by an experienced minimally invasive surgeon. Further studies with longer follow-ups are needed to confirm the long-term effectiveness of this technique.
KW - celiac artery decompression
KW - laparoscopic surgery
KW - median arcuate ligament release
KW - median arcuate ligament syndrome
KW - minimally invasive surgery
UR - http://www.scopus.com/inward/record.url?scp=85184149409&partnerID=8YFLogxK
U2 - 10.1097/SLE.0000000000001257
DO - 10.1097/SLE.0000000000001257
M3 - Article
C2 - 38190634
AN - SCOPUS:85184149409
SN - 1530-4515
VL - 34
SP - 74
EP - 79
JO - Surgical Laparoscopy, Endoscopy and Percutaneous Techniques
JF - Surgical Laparoscopy, Endoscopy and Percutaneous Techniques
IS - 1
ER -