Juan Carlos Jimenez1, Michael Harlander-Locke, Erik P Dutson. 1. Gonda, Goldschmied, Vascular Center, Division of Vascular Surgery, David Geffen School of Medicine at the University of California, Los Angeles, Calif, USA. jcjimenez@mednet.ucla.edu
Abstract
BACKGROUND: Median arcuate ligament syndrome (MALS) is a syndrome associated with chronic abdominal pain and radiographic evidence of celiac artery compression. We compared the evidence for both open and laparoscopic treatment of patients with MALS. METHODS: We reviewed the English-language literature between 1963 and 2012. Presenting symptoms, clinical improvement, operative details, and intraoperative and postoperative complications were noted. RESULTS: A total of 400 patients underwent surgical (open and laparoscopic) treatment for MALS. Three hundred thirty-nine patients reported immediate postoperative symptom relief (85%). Late recurrence of symptoms was reported in 19 patients in the open group (6.8%) and seven patients in the laparoscopic group (5.7%). Eleven out of 121 patients (9.1%) in the laparoscopic group required open conversion secondary to bleeding. CONCLUSIONS: The available evidence demonstrates that both laparoscopic and open ligament release, celiac ganglionectomy, and celiac artery revascularization may provide sustained symptom relief in the majority of patients diagnosed with MALS. The role of arterial revascularization following ligament release remains unclear. The rate of open conversion with the laparoscopic approach is high, but no perioperative deaths have been reported.
BACKGROUND: Median arcuate ligament syndrome (MALS) is a syndrome associated with chronic abdominal pain and radiographic evidence of celiac artery compression. We compared the evidence for both open and laparoscopic treatment of patients with MALS. METHODS: We reviewed the English-language literature between 1963 and 2012. Presenting symptoms, clinical improvement, operative details, and intraoperative and postoperative complications were noted. RESULTS: A total of 400 patients underwent surgical (open and laparoscopic) treatment for MALS. Three hundred thirty-nine patients reported immediate postoperative symptom relief (85%). Late recurrence of symptoms was reported in 19 patients in the open group (6.8%) and seven patients in the laparoscopic group (5.7%). Eleven out of 121 patients (9.1%) in the laparoscopic group required open conversion secondary to bleeding. CONCLUSIONS: The available evidence demonstrates that both laparoscopic and open ligament release, celiac ganglionectomy, and celiac artery revascularization may provide sustained symptom relief in the majority of patients diagnosed with MALS. The role of arterial revascularization following ligament release remains unclear. The rate of open conversion with the laparoscopic approach is high, but no perioperative deaths have been reported.
Authors: Jesse A Columbo; Thadeus Trus; Brian Nolan; Philip Goodney; Eva Rzucidlo; Richard Powell; Daniel Walsh; David Stone Journal: J Vasc Surg Date: 2015-03-07 Impact factor: 4.268
Authors: Michael V Do; Taylor A Smith; Hernan A Bazan; W C Sternbergh; Abbas E Abbas; William S Richardson Journal: Surg Endosc Date: 2013-07-12 Impact factor: 4.584