Robotic Median Arcuate Ligament Release May Offer Superior Symptom Improvement to Laparoscopic Release.

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.