Robert Grossman, MD, Ben Biteman, MD, Fred Brody, MD, MBA. George Washington University
Introduction: Median arcuate ligament syndrome (MALS) is a relative rare disorder, characterized by symptoms including nausea, emesis, post-prandial pain, and weight loss. Relief from this disorder may be obtained by dividing the celiac plexus. This videos present a single institution series of 56 patients diagnosed with MALS and treated with a laparoscopic MAL release.
Methods: All patients undergo a thorough history and physical, as well as celiac artery ultrasound for examination of celiac velocities at rest, during inspiration, and during expiration. Magnetic resonance angiography, computed tomography angiography, or aortograms are used in selected patients to confirm the diagnosis. Prior to surgery, a short-form 36 questionnaire is given to all patients; this questionnaire is repeated at 6- and 12-months post-operatively. Additionally, celiac ultrasound is repeated at the same interval. A standard 5 port foregut port set-up is used to perform the laparoscopic MAL release. Briefly, the celiac trifurcation is exposed and then the overlying fascia and muscle is divided over the aorta including the crura, the MAL, and the ligament to the fourth portion of the duodenum. All of the associated neurovascular bundles are divided as well. Finally, the lateral and medial celiac ganglion are divided.
Results: To date, 56 patients have had a laparoscopic MAL release. Thirty-five patients have 1-year SF-36 follow-up data, and 17 patients have 1-year celiac artery ultrasonography follow-up. The average age is 35.11 years, and 91% of our patients are female. A statistically significant difference was found in SF-36 responses preoperatively and at 12 months, implying a significant improvement in patient-reported quality of life. A trend towards statistical significance was noted for all ultrasound findings at rest, inspiration, and expiration.
Conclusion: MALS is a rare disorder that may result in nausea, emesis, post-prandial pain, and weight loss, particularly in younger women. Diagnosis may be obtained with a combination of clinical suspicion and radiologic findings. Laparoscopic MAL release is a safe procedure that can improve patient quality of life significantly.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79881
Program Number: V130
Presentation Session: MIS – Cool Stuff
Presentation Type: Video