An 8-Year Experience of Robot-Assisted Laparoscopic Surgical Management of Median Arcuate Ligament Syndrome.
Background: Due to the rarity of median arcuate ligament syndrome (MALS), surgical approaches to median arcuate ligament release (MALR) have been understudied. This series aimed to review robot-assisted laparoscopic MALR from a quaternary care center.
Methods: This is a single-center cohort study of adult patients who underwent robot-assisted laparoscopic MALR between March 2015 and June 2023. Clinicopathologic data were abstracted from the electronic medical record for patients with at least 30 days of follow-up. Our primary outcome was symptom improvement, which was assessed via review of the medical record from postoperative patient visits with a provider. Bivariate analyses were performed using Fisher's exact test.
Results: Twenty patients were identified. The mean age of patients at the time of surgery was 41.65 (±16.02), and 16 (80%) of the patients were female. Many patients had concomitant diagnoses of gastrointestinal illnesses, including Crohn's or irritable bowel syndrome (IBS) (40%) and gastroesophageal reflux disease (GERD) (35%). Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5) psychiatric illnesses were diagnosed in 13 (65%) patients. The most frequently encountered preoperative chronic symptoms included postprandial pain (90%), chronic abdominal pain (85%), and unintended weight loss (85%). Postoperatively, 10 patients experienced complete resolution of unintended weight loss (P = 0.0031) and significant improvement in chronic MALS symptoms, including abdominal pain, postprandial pain, nausea, and unintended weight loss. The median follow-up time was 1.63 (0.97-2.69) years. Operative characteristics include the mean operative time of 133.25 ± 25.91 minutes, median estimated blood loss of 20 (8.75-25.00) mL, and no significant changes in inspiratory or expiratory celiac artery peak systolic velocity between measurements before and after robot-assisted laparoscopic median arcuate ligament release (R-MALR). Patients had a median length of stay of 2 (1-3) days. 2 of 20 patients (10%) experienced a return to the operating room for an injury to the gastroesophageal junction and pseudoaneurysm of the left gastric artery. There were no mortalities within 30 days of operation.
Conclusions: Our single-institution experience offers evidence that R-MALR release can be a safe and effective option for medium-term relief of MALS symptoms.