Mauro Podda1, Gian Pietro Gusai1, Francesco Balestra1, Giulio Argenio2, Fabio Pulighe1, Salomone Di Saverio3, Carlo De Nisco1. 1. Department of General, Emergency and Robotic Surgery, San Francesco Hospital, Italy. 2. Department of General and Oncological Surgery, SS Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy. 3. Maggiore Hospital Regional Emergency Surgery and Trauma Center, Bologna Local Health District Bologna, Italy and Consultant Surgeon, Addenbrookes Hospital - University of Cambridge, UK.
Abstract
BACKGROUND: Median Arcuate Ligament Syndrome (MALS) is a rare clinical condition. METHODS: Through the analysis of a case report and a review of the international literature, we examined whether robotic and laparoscopic MAL release are safe and feasible. RESULTS: Of 354 and 19 patients who underwent laparoscopic MAL release (LMALr) and robotic-assisted MAL release (RMALr), respectively, conversion to open surgery occurred in 6.8% of cases following LMALr, whereas no case of conversion was reported following RMALr. Immediate symptomatic improvement was reported in 92.1% of cases following LMALr and in 84.2% of cases following RMALr. In the LMALr group 9% of patients presented with recurrence of symptoms, whereas the percentage in the RMALr group was 5.3%. LMALr was related to a higher overall complication rate when compared with RMALr (7.3% vs 5.3%). CONCLUSIONS: Both laparoscopic and robotic-assisted MAL lysis with celiac ganglionectomy can be safely performed with minimal patient morbidity.
BACKGROUND: Median Arcuate Ligament Syndrome (MALS) is a rare clinical condition. METHODS: Through the analysis of a case report and a review of the international literature, we examined whether robotic and laparoscopic MAL release are safe and feasible. RESULTS: Of 354 and 19 patients who underwent laparoscopic MAL release (LMALr) and robotic-assisted MAL release (RMALr), respectively, conversion to open surgery occurred in 6.8% of cases following LMALr, whereas no case of conversion was reported following RMALr. Immediate symptomatic improvement was reported in 92.1% of cases following LMALr and in 84.2% of cases following RMALr. In the LMALr group 9% of patients presented with recurrence of symptoms, whereas the percentage in the RMALr group was 5.3%. LMALr was related to a higher overall complication rate when compared with RMALr (7.3% vs 5.3%). CONCLUSIONS: Both laparoscopic and robotic-assisted MAL lysis with celiac ganglionectomy can be safely performed with minimal patient morbidity.