Michael Pryor1, Colton J Fernstrum1, Andrea Wolf, MD2, Paul Wright, MD2. 1Michigan State University College of Human Medicine, 2Spectrum Health
INTRODUCTION: Median arcuate ligament syndrome (MALS) results from compression of the proximal celiac artery and celiac ganglion by the median arcuate ligament of the diaphragmatic crura. Minimal reports on treatment outcomes are available in the current published literature. We sought to examine outcomes in a consecutive cohort of patients with MALS treated by robotic median arcuate ligament release to evaluate the safety and efficacy of this approach.
METHODS AND PROCEDURES: A retrospective chart review was performed to include consecutive patients with MALS that underwent robotic median arcuate ligament release from August 2012 to April 2018. Standard patient workup included history and physical examination, CT scan, and mesenteric Doppler ultrasound. Select patients underwent diagnostic angiography. Demographics, diagnostics, intra- and post-operative data were collected for each patient. The primary outcome measure was improvement/resolution of pain at first follow-up visit. Secondary outcomes included operative duration, length of stay, postoperative complications, and liberation from narcotics.
RESULTS: Twenty-seven patients were found to meet the inclusion criteria and were included for study. Mean age of the cohort was 49±15.5 years and two-thirds were female. The most common pre-operative symptoms were post-prandial abdominal pain (25/27, 93%), persistent/constant abdominal pain (16/27, 59%), weight loss (15/27, 56%), and nausea (14/27, 52%). Duration of symptoms was <6 months in 14 (52%), 6-12 months in 2 (7%), and >12 months in 11 (41%). Sixteen patients (59%) were using narcotic medications for their pain at the time of surgical evaluation. CT was performed in 24 (89%), mesenteric Doppler ultrasound in 19 (70%), and angiogram in 6 (22%). Celiac stenosis >70% was observed in 24 (89%) while median peak velocity was 311 cm/s (range 184-562). Median operative duration was 95 minutes (range 53-358) and estimated blood loss was <100 mL in 24/27 (89%) cases. Length of stay was one day in 22/27 (81%). Two cases required conversion to open, the first related to adhesive disease and the second due to disruption of the celiac trunk requiring ligation to control hemorrhage. This was the only major complication and this patient was discharged home on postoperative day 6. Twenty patients (74%) had complete and three (11%) partial symptom resolution at initial follow-up for an 85% treatment response rate. Narcotic liberation was achieved in 9/16 (56%).
CONCLUSIONS: Robotic MAL release offers an attractive option for treatment of MALS with high response rates to treatment, short hospital stay, and opportunity for narcotic liberation.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94958
Program Number: P697
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster