Outcomes of Median Arcuate Ligament Release and Celiac Plexus Neurolysis in 72 Patients with Median Arcuate Ligament Syndrome.

BACKGROUND

Median arcuate ligament syndrome (MALS) is defined as compression of the celiac artery and celiac ganglion by the median arcuate ligament. Classical symptoms include postprandial epigastric pain and weight loss. Typically, ultrasonography and computed tomography angiography show increased celiac artery velocities and stenosis. Currently, no diagnostic algorithm exists to identify MALS patients most likely to benefit from median arcuate ligament release (MALR). We sought to determine the effect of age, underlying psychiatric diagnosis, and the presence of classic MALS imaging and symptomatology findings on postsurgical quality of life (QOL) to inform management of MALS.

METHODS

This retrospective study used prospectively collected 36-item short form survey QOL questionnaires, electronic medical record review, and patient interviews to document presurgical symptoms, imaging results, and demographic data on 72 patients who underwent MALR. Patients were stratified by prior psychiatric diagnosis and age (0-19, 20-29, 30-49, and over 50 years old).

RESULTS

In patients with both classic MALS symptoms and imaging (n = 31), QOL improved by 1.25x, whereas patients with classic imaging who did not meet the MALS symptom criteria (n = 11) improved by 0.35x (P < 0.004) (Figure 5). Subjects with (n = 30) and without (n = 13) prior psychiatric diagnosis exhibited 0.97x and 1.12x improvement, respectively (P < 0.784) (Figure 6). One way analysis of variance did not demonstrate a difference in improvement between age groups (P < 0.302) (Figure 7).

CONCLUSION

In the largest single surgeon study on MALS to date, classic symptoms and imaging led to greater QOL improvements compared to imaging findings alone. Psychiatric history and age were not significant predictors of QOL improvement following MALR. Classic symptoms and imaging, regardless of psychiatric history or age, indicate the greatest benefit from MALR.