Short and longterm outcome of minimally invasive therapy of median arcuate ligament syndrome.

IF 2.1 3区 医学 Q2 SURGERY
Frederike Butz, Oliver Haase, Friederike Martin, Karl Herbert Hillebrandt, Sebastian Knitter, Wenzel Schöning, Nathanael Raschzok, Johann Pratschke, Felix Krenzien
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Abstract

Purpose: Median arcuate ligament syndrome (MALS) is a rare disorder caused by compression of the celiac artery (CA) by the median arcuate ligament (MAL). Common symptoms include postprandial abdominal pain, diarrhea, and weight loss. While laparoscopic MAL division has long been considered the procedure of choice, robotic-assisted procedures have been increasingly used since their introduction. Aim of this study was to evaluate peri- and postoperative outcomes after minimally invasive MAL release.

Methods: A retrospective analysis of patients undergoing minimally invasive MAL release at the Department of Surgery, Charité - Universitätsmedizin Berlin, between 2014 and 2023 was performed.

Results: 20 patients met the inclusion criteria and underwent either laparoscopic (n = 3) or robotic (n = 17) MAL release. Most common preoperative symptoms were postprandial abdominal pain (90%), weight loss (45%), diarrhea (30%), and nausea (25%). Comparing laparoscopic and robotic surgery, neither the median duration of surgery (minutes: 98 (90-290) vs. 125 (80-254); p = 0.765), the median length of hospital stay (days: 4 (3-4) vs. 5 (3-6); p = 0.179) and intraoperative blood loss (< 50 ml in both groups, p = 1.0) showed significant differences. Peak systolic velocity in the CA was significantly reduced postoperatively (cm/s: 320 (200-765) vs. 167 (100-500), p < 0.001). Postoperatively, 17 (85%) patients reported symptom improvement, while 4 (20%) patients had no symptom relief at last follow-up. In 3 cases, follow-up imaging showed evidence of respiratory-related CA stenosis.

Conclusion: Despite being complex and challenging procedures, laparoscopic and robotic-assisted MAL release are safe procedures with low risk of postoperative complications and good longterm outcomes.

正中弓形韧带综合征微创疗法的短期和长期疗效。
目的:正中弓形韧带综合征(MALS)是一种罕见的疾病,由正中弓形韧带(MAL)压迫腹腔动脉(CA)引起。常见症状包括餐后腹痛、腹泻和体重减轻。虽然腹腔镜 MAL 切除术一直被认为是首选手术,但自机器人辅助手术问世以来,其应用也越来越广泛。本研究旨在评估微创MAL松解术的围手术期和术后效果:结果:20名患者符合纳入标准,接受了腹腔镜(3人)或机器人(17人)MAL微创松解术。最常见的术前症状是餐后腹痛(90%)、体重下降(45%)、腹泻(30%)和恶心(25%)。腹腔镜手术和机器人手术的中位手术时间(98 分钟(90-290 分钟)vs.....:98 (90-290) vs. 125 (80-254); p = 0.765),住院时间中位数(天数:4 (3-4) vs. 5 (3-4); p = 0.765):4 (3-4) vs. 5 (3-6);p = 0.179)和术中失血量(结论:腹腔镜手术是一种复杂而具有挑战性的手术:尽管腹腔镜和机器人辅助 MAL 释放术是复杂且具有挑战性的手术,但它们都是安全的手术,术后并发症风险低,长期疗效好。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
3.30
自引率
8.70%
发文量
342
审稿时长
4-8 weeks
期刊介绍: Langenbeck''s Archives of Surgery aims to publish the best results in the field of clinical surgery and basic surgical research. The main focus is on providing the highest level of clinical research and clinically relevant basic research. The journal, published exclusively in English, will provide an international discussion forum for the controlled results of clinical surgery. The majority of published contributions will be original articles reporting on clinical data from general and visceral surgery, while endocrine surgery will also be covered. Papers on basic surgical principles from the fields of traumatology, vascular and thoracic surgery are also welcome. Evidence-based medicine is an important criterion for the acceptance of papers.
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