Kayla A Fay, Jennifer A Stableford, Jesse A Columbo, David H Stone, David J Finley
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引用次数: 0
Abstract
Introduction/objective: Median arcuate ligament syndrome (MALS) is a challenging disease process to treat. Laparoscopic ligament release can lead to early symptom improvement, but symptom recurrence is common. Recently, these MAL releases are being performed robotically at select institutions. The purpose of this study was to document symptom resolution and recurrence rates after laparoscopic and robotic MAL release (r-MALR) at our institution.
Methods: We performed a retrospective review of all patients treated with minimally invasive MAL release at a single academic tertiary medical center from 2017 - 2023. We stratified patients by operative approach, laparoscopic versus robotic. Our primary outcome was symptom resolution at 6-month follow-up.
Results: We identified 38 patients who underwent MAL release, 27 (71.1%) that underwent laparoscopic release, and 11 (28.9%) that underwent r-MALR. Pre-operative characteristics were similar between groups, including age (37.0 years vs. 41.1 years, p=0.45) and preoperative psychiatric diagnosis (60.0% vs. 36.4%, p=0.28). Patients who underwent a r-MALR had a higher likelihood of postoperative symptom resolution when compared to those who underwent a laparoscopic release at both 1 month (81.8% vs. 20%, p=0.001) and 6 months (54.5% vs. 4%, p=0.001). Post-operative length of stay was lower in the laparoscopic group (median 0 days vs. 1 day, p=0.03), and there were more frequent reports of new post-operative gastrointestinal symptoms after r-MALR (27.3% v. 4.0%, p=0.08).
Conclusions: R-MALR was associated with improved symptom resolution at 1-month and 6-months post-operatively when compared to laparoscopic release. r-MALR should be considered for patients who have this challenging disease entity.
简介/目的：正中弓韧带综合征（MALS）是一种具有挑战性的疾病治疗过程。腹腔镜下韧带松解可导致早期症状改善，但症状复发是常见的。最近，这些MAL发布在选定的机构中被机器人地执行。本研究的目的是记录我院腹腔镜和机器人手术后的症状缓解和复发率。方法：我们对2017 - 2023年在一家学术三级医疗中心接受微创MAL释放治疗的所有患者进行回顾性分析。我们通过手术方式对患者进行分层，腹腔镜还是机器人。我们的主要结局是6个月随访时症状的缓解。结果：我们确定了38例接受MAL释放的患者，27例（71.1%）接受腹腔镜释放，11例（28.9%）接受r-MALR。两组术前特征相似，包括年龄（37.0岁比41.1岁，p=0.45）和术前精神诊断（60.0%比36.4%,p=0.28）。接受r-MALR的患者在1个月（81.8% vs. 20%, p=0.001）和6个月（54.5% vs. 4%, p=0.001）时与接受腹腔镜释放的患者相比，术后症状缓解的可能性更高。腹腔镜组术后住院时间较低（中位数0天vs 1天，p=0.03）， r-MALR术后出现新的胃肠道症状的报告频率更高（27.3% vs 4.0%, p=0.08）。结论：与腹腔镜释放相比，R-MALR与术后1个月和6个月症状缓解改善有关。对于患有这种具有挑战性的疾病实体的患者，应考虑r-MALR。
期刊介绍：
Annals of Vascular Surgery, published eight times a year, invites original manuscripts reporting clinical and experimental work in vascular surgery for peer review. Articles may be submitted for the following sections of the journal:
Clinical Research (reports of clinical series, new drug or medical device trials)
Basic Science Research (new investigations, experimental work)
Case Reports (reports on a limited series of patients)
General Reviews (scholarly review of the existing literature on a relevant topic)
Developments in Endovascular and Endoscopic Surgery
Selected Techniques (technical maneuvers)
Historical Notes (interesting vignettes from the early days of vascular surgery)
Editorials/Correspondence
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