Outcomes of 100 consecutive minimally invasive operations for median arcuate ligament syndrome: a single surgeon experience.

INTRODUCTION

Reported outcomes after surgical treatment for Median Arcuate Ligament Syndrome (MALS) vary, with treatment success ranging from 40 to 90.3%. We describe our diagnostic algorithm, predictors of success, and evaluate the safety and efficacy of surgical treatment by a single surgeon through a robotic-assisted approach.

METHODS AND PROCEDURE: Retrospective chart review was performed for patients who underwent minimally invasive surgery for MALS from November 2016 to October 2024. 100 consecutive patients qualified for inclusion. Patients undergoing revisional surgery after a primary procedure by another surgeon were excluded. Patients were diagnosed with MALS based on CT/MR abdomen/pelvis, mesenteric duplex, or positive response to a celiac nerve ganglion block (CGNB), and clinical symptoms. Data on patient demographics, preoperative evaluation, peri- and postoperative outcomes were collected.

RESULTS

All patients underwent minimally invasive celiac artery decompression and median arcuate ligament release. Ninety five also underwent celiac ganglion nerve plexus resection. Average age was 29 years. Mean operative time was 126 min. Average length of stay was 2.8 days. There were three intraoperative complications, including one conversion to open surgery, and one postoperative complication, which required reoperation for chylous ascites. Average length of follow-up was 10.7 months (range 2 weeks to 5.8 years). 94.9% experienced relief of chronic abdominal pain. Only five patients did not experience any improvement. Forty seven patients presented with chronic epigastric abdominal pain worsened with all foods, significant weight loss (> 10 pounds), and a CGNB that provided relief, of which 95.7% experienced significant(≥ 50%) postoperative pain score improvement.

CONCLUSION

In this series of 100 patients, 94 experienced symptomatic relief after surgical treatment for MALS. Proper patient selection and accurate diagnosis are crucial for successful outcomes. Patients with classic symptoms of MALS, namely, epigastric abdominal pain with all foods, significant weight loss, and relief with a preoperative CGNB, will have a 95% chance of symptomatic improvement.