Laparoscopic Versus Robotic-Assisted Surgery for Median Arcuate Ligament Syndrome

Michael Do, MD, William Richardson, Abbas Abbas, MD, Charles Sternbergh, MD, Hernan Bazan, MD, Taylor Smith, MD

Ochsner Clinic Foundation

Introduction: In this study we compare our outcomes using laparoscopic and robotic-assisted treatment of MALS. Median arcuate ligament syndrome (MALS) is an uncommon disorder characterized by postprandial abdominal pain, weight loss, and vomiting related to the compression of the celiac artery by the median arcuate ligament. This syndrome has been classically treated with an open approach. More recently, laparoscopic and robotic approaches have been described.

Methods: A retrospective review was performed on all patients treated for MALS from March 2006 to August 2012 at a single institution. Statistical analysis was performed using Microsoft Excel with two-tailed t tests.

Results: A total of 16 patients with MALS were treated, 12 patients via a laparoscopic approach and 4 patients via a robotic-assisted approach. Patient characteristics and comorbidities were similar between groups. There were no intraoperative or perioperative conversions, complications, or deaths. The mean operative time for the laparoscopic approach was significantly shorter than for the robotic approach (101.7 minutes vs 145.8 minutes, P = 0.049). There was no significant difference in length of hospital stay (1.7 days vs 1.3 days, P = 0.65). Mean length of follow-up for laparoscopically treated patients was 6.8 months, for robotically treated patients 1 month (P = 0.34). Four patients (33%) in the laparoscopic group and one patient (25%) in the robotic group had recurrent post-operative abdominal pain (P = 0.77). Two laparoscopically treated patients (50%) and two robotically treated patients (67%) had stopped taking chronic narcotics post-operatively.

Conclusion: Both laparoscopic and robotic approaches to MALS treatment can be performed with minimal morbidity and mortality. The laparoscopic approach was associated with significantly shorter operative time. While innovative, the true advantages to robotic-assisted MALS surgery are yet to be seen.

Session: Podium Presentation

Program Number: S035