An 8-Year Experience of Robot-Assisted Laparoscopic Surgical Management of Median Arcuate Ligament Syndrome

Abstract

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.

Conclusion

Our single-institution experience offers evidence that R-MALR release can be a safe and effective option for medium-term relief of MALS symptoms.