Short and longterm outcome of minimally invasive therapy of median arcuate ligament syndrome
Purpose Median arcuate ligament syndrome (MALS) is a rare disorder caused by compression of the celiac artery (CA) by the median arcuate ligament (MAL). Common symptoms include postprandial abdominal pain, diarrhea, and weight loss. While laparoscopic MAL division has long been considered the proced...
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| creator | Butz, Frederike Haase, Oliver Martin, Friederike Hillebrandt, Karl Herbert Knitter, Sebastian Schöning, Wenzel Raschzok, Nathanael Pratschke, Johann Krenzien, Felix |
| description | Purpose
Median arcuate ligament syndrome (MALS) is a rare disorder caused by compression of the celiac artery (CA) by the median arcuate ligament (MAL). Common symptoms include postprandial abdominal pain, diarrhea, and weight loss. While laparoscopic MAL division has long been considered the procedure of choice, robotic-assisted procedures have been increasingly used since their introduction. Aim of this study was to evaluate peri- and postoperative outcomes after minimally invasive MAL release.
Methods
A retrospective analysis of patients undergoing minimally invasive MAL release at the Department of Surgery, Charité - Universitätsmedizin Berlin, between 2014 and 2023 was performed.
Results
20 patients met the inclusion criteria and underwent either laparoscopic (
n
= 3) or robotic (
n
= 17) MAL release. Most common preoperative symptoms were postprandial abdominal pain (90%), weight loss (45%), diarrhea (30%), and nausea (25%). Comparing laparoscopic and robotic surgery, neither the median duration of surgery (minutes: 98 (90–290) vs. 125 (80–254);
p
= 0.765), the median length of hospital stay (days: 4 (3–4) vs. 5 (3–6);
p
= 0.179) and intraoperative blood loss ( |
| doi_str_mv | 10.1007/s00423-024-03511-9 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_11502543</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>3120061703</sourcerecordid><originalsourceid>FETCH-LOGICAL-c328t-ded48b673c82ea25d8c6354c03111f3fa45a430e8f748750e998b008fc68689d3</originalsourceid><addsrcrecordid>eNp9kU9P3DAQxa0KVCjtF-gB-cgl7fhf4pyqClFAQuIAvVWyvM5k1yixFztZab99DbtdwaUnj_Te_Pw0j5CvDL4xgOZ7BpBcVMBlBUIxVrUfyCmTQlVcKnb0Zj4hn3J-AoC6aeVHciJaKWvW1Kfkz8Mqpona0NEhhuWEaaRxnlwckcaejj740Q7DlvqwsdlvkE4rTHa9fVWx8zZQm9xsJ6SDX9oRw0TzNnSpED6T494OGb_s3zPy-9fV4-VNdXd_fXv5865yguup6rCTelE3wmmOlqtOu1oo6UAwxnrRW6msFIC6b6RuFGDb6gWA7l2ta9124oz82HHX86JkciVDsoNZp5I9bU203rxXgl-ZZdwYxhRwJUUhXOwJKT7PmCcz-uxwGGzAOGcjGC_HYw28WPnO6lLMOWF_-IeBeenF7HoxpRfz2otpy9L524SHlX9FFIPYGXKRwhKTeYpzCuVq_8P-BRsMmnA</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>3120061703</pqid></control><display><type>article</type><title>Short and longterm outcome of minimally invasive therapy of median arcuate ligament syndrome</title><source>MEDLINE</source><source>Springer Nature - Complete Springer Journals</source><creator>Butz, Frederike ; Haase, Oliver ; Martin, Friederike ; Hillebrandt, Karl Herbert ; Knitter, Sebastian ; Schöning, Wenzel ; Raschzok, Nathanael ; Pratschke, Johann ; Krenzien, Felix</creator><creatorcontrib>Butz, Frederike ; Haase, Oliver ; Martin, Friederike ; Hillebrandt, Karl Herbert ; Knitter, Sebastian ; Schöning, Wenzel ; Raschzok, Nathanael ; Pratschke, Johann ; Krenzien, Felix</creatorcontrib><description>Purpose
Median arcuate ligament syndrome (MALS) is a rare disorder caused by compression of the celiac artery (CA) by the median arcuate ligament (MAL). Common symptoms include postprandial abdominal pain, diarrhea, and weight loss. While laparoscopic MAL division has long been considered the procedure of choice, robotic-assisted procedures have been increasingly used since their introduction. Aim of this study was to evaluate peri- and postoperative outcomes after minimally invasive MAL release.
Methods
A retrospective analysis of patients undergoing minimally invasive MAL release at the Department of Surgery, Charité - Universitätsmedizin Berlin, between 2014 and 2023 was performed.
Results
20 patients met the inclusion criteria and underwent either laparoscopic (
n
= 3) or robotic (
n
= 17) MAL release. Most common preoperative symptoms were postprandial abdominal pain (90%), weight loss (45%), diarrhea (30%), and nausea (25%). Comparing laparoscopic and robotic surgery, neither the median duration of surgery (minutes: 98 (90–290) vs. 125 (80–254);
p
= 0.765), the median length of hospital stay (days: 4 (3–4) vs. 5 (3–6);
p
= 0.179) and intraoperative blood loss (< 50 ml in both groups,
p
= 1.0) showed significant differences. Peak systolic velocity in the CA was significantly reduced postoperatively (cm/s: 320 (200–765) vs. 167 (100–500),
p
< 0.001). Postoperatively, 17 (85%) patients reported symptom improvement, while 4 (20%) patients had no symptom relief at last follow-up. In 3 cases, follow-up imaging showed evidence of respiratory-related CA stenosis.
Conclusion
Despite being complex and challenging procedures, laparoscopic and robotic-assisted MAL release are safe procedures with low risk of postoperative complications and good longterm outcomes.</description><identifier>ISSN: 1435-2451</identifier><identifier>ISSN: 1435-2443</identifier><identifier>EISSN: 1435-2451</identifier><identifier>DOI: 10.1007/s00423-024-03511-9</identifier><identifier>PMID: 39446176</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Abdominal Surgery ; Adult ; Aged ; Cardiac Surgery ; Celiac Artery - surgery ; Female ; General Surgery ; Humans ; Laparoscopy - methods ; Length of Stay ; Male ; Median Arcuate Ligament Syndrome - surgery ; Medicine ; Medicine & Public Health ; Middle Aged ; Minimally Invasive Surgical Procedures - methods ; Retrospective Studies ; Robotic Surgical Procedures ; Thoracic Surgery ; Traumatic Surgery ; Treatment Outcome ; Vascular Surgery</subject><ispartof>Langenbeck's archives of surgery, 2024-10, Vol.409 (1), p.322, Article 322</ispartof><rights>The Author(s) 2024</rights><rights>2024. The Author(s).</rights><rights>The Author(s) 2024 2024</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c328t-ded48b673c82ea25d8c6354c03111f3fa45a430e8f748750e998b008fc68689d3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00423-024-03511-9$$EPDF$$P50$$Gspringer$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00423-024-03511-9$$EHTML$$P50$$Gspringer$$Hfree_for_read</linktohtml><link.rule.ids>230,314,776,780,881,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/39446176$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Butz, Frederike</creatorcontrib><creatorcontrib>Haase, Oliver</creatorcontrib><creatorcontrib>Martin, Friederike</creatorcontrib><creatorcontrib>Hillebrandt, Karl Herbert</creatorcontrib><creatorcontrib>Knitter, Sebastian</creatorcontrib><creatorcontrib>Schöning, Wenzel</creatorcontrib><creatorcontrib>Raschzok, Nathanael</creatorcontrib><creatorcontrib>Pratschke, Johann</creatorcontrib><creatorcontrib>Krenzien, Felix</creatorcontrib><title>Short and longterm outcome of minimally invasive therapy of median arcuate ligament syndrome</title><title>Langenbeck's archives of surgery</title><addtitle>Langenbecks Arch Surg</addtitle><addtitle>Langenbecks Arch Surg</addtitle><description>Purpose
Median arcuate ligament syndrome (MALS) is a rare disorder caused by compression of the celiac artery (CA) by the median arcuate ligament (MAL). Common symptoms include postprandial abdominal pain, diarrhea, and weight loss. While laparoscopic MAL division has long been considered the procedure of choice, robotic-assisted procedures have been increasingly used since their introduction. Aim of this study was to evaluate peri- and postoperative outcomes after minimally invasive MAL release.
Methods
A retrospective analysis of patients undergoing minimally invasive MAL release at the Department of Surgery, Charité - Universitätsmedizin Berlin, between 2014 and 2023 was performed.
Results
20 patients met the inclusion criteria and underwent either laparoscopic (
n
= 3) or robotic (
n
= 17) MAL release. Most common preoperative symptoms were postprandial abdominal pain (90%), weight loss (45%), diarrhea (30%), and nausea (25%). Comparing laparoscopic and robotic surgery, neither the median duration of surgery (minutes: 98 (90–290) vs. 125 (80–254);
p
= 0.765), the median length of hospital stay (days: 4 (3–4) vs. 5 (3–6);
p
= 0.179) and intraoperative blood loss (< 50 ml in both groups,
p
= 1.0) showed significant differences. Peak systolic velocity in the CA was significantly reduced postoperatively (cm/s: 320 (200–765) vs. 167 (100–500),
p
< 0.001). Postoperatively, 17 (85%) patients reported symptom improvement, while 4 (20%) patients had no symptom relief at last follow-up. In 3 cases, follow-up imaging showed evidence of respiratory-related CA stenosis.
Conclusion
Despite being complex and challenging procedures, laparoscopic and robotic-assisted MAL release are safe procedures with low risk of postoperative complications and good longterm outcomes.</description><subject>Abdominal Surgery</subject><subject>Adult</subject><subject>Aged</subject><subject>Cardiac Surgery</subject><subject>Celiac Artery - surgery</subject><subject>Female</subject><subject>General Surgery</subject><subject>Humans</subject><subject>Laparoscopy - methods</subject><subject>Length of Stay</subject><subject>Male</subject><subject>Median Arcuate Ligament Syndrome - surgery</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Minimally Invasive Surgical Procedures - methods</subject><subject>Retrospective Studies</subject><subject>Robotic Surgical Procedures</subject><subject>Thoracic Surgery</subject><subject>Traumatic Surgery</subject><subject>Treatment Outcome</subject><subject>Vascular Surgery</subject><issn>1435-2451</issn><issn>1435-2443</issn><issn>1435-2451</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>C6C</sourceid><sourceid>EIF</sourceid><recordid>eNp9kU9P3DAQxa0KVCjtF-gB-cgl7fhf4pyqClFAQuIAvVWyvM5k1yixFztZab99DbtdwaUnj_Te_Pw0j5CvDL4xgOZ7BpBcVMBlBUIxVrUfyCmTQlVcKnb0Zj4hn3J-AoC6aeVHciJaKWvW1Kfkz8Mqpona0NEhhuWEaaRxnlwckcaejj740Q7DlvqwsdlvkE4rTHa9fVWx8zZQm9xsJ6SDX9oRw0TzNnSpED6T494OGb_s3zPy-9fV4-VNdXd_fXv5865yguup6rCTelE3wmmOlqtOu1oo6UAwxnrRW6msFIC6b6RuFGDb6gWA7l2ta9124oz82HHX86JkciVDsoNZp5I9bU203rxXgl-ZZdwYxhRwJUUhXOwJKT7PmCcz-uxwGGzAOGcjGC_HYw28WPnO6lLMOWF_-IeBeenF7HoxpRfz2otpy9L524SHlX9FFIPYGXKRwhKTeYpzCuVq_8P-BRsMmnA</recordid><startdate>20241024</startdate><enddate>20241024</enddate><creator>Butz, Frederike</creator><creator>Haase, Oliver</creator><creator>Martin, Friederike</creator><creator>Hillebrandt, Karl Herbert</creator><creator>Knitter, Sebastian</creator><creator>Schöning, Wenzel</creator><creator>Raschzok, Nathanael</creator><creator>Pratschke, Johann</creator><creator>Krenzien, Felix</creator><general>Springer Berlin Heidelberg</general><scope>C6C</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20241024</creationdate><title>Short and longterm outcome of minimally invasive therapy of median arcuate ligament syndrome</title><author>Butz, Frederike ; Haase, Oliver ; Martin, Friederike ; Hillebrandt, Karl Herbert ; Knitter, Sebastian ; Schöning, Wenzel ; Raschzok, Nathanael ; Pratschke, Johann ; Krenzien, Felix</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c328t-ded48b673c82ea25d8c6354c03111f3fa45a430e8f748750e998b008fc68689d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Abdominal Surgery</topic><topic>Adult</topic><topic>Aged</topic><topic>Cardiac Surgery</topic><topic>Celiac Artery - surgery</topic><topic>Female</topic><topic>General Surgery</topic><topic>Humans</topic><topic>Laparoscopy - methods</topic><topic>Length of Stay</topic><topic>Male</topic><topic>Median Arcuate Ligament Syndrome - surgery</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Minimally Invasive Surgical Procedures - methods</topic><topic>Retrospective Studies</topic><topic>Robotic Surgical Procedures</topic><topic>Thoracic Surgery</topic><topic>Traumatic Surgery</topic><topic>Treatment Outcome</topic><topic>Vascular Surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Butz, Frederike</creatorcontrib><creatorcontrib>Haase, Oliver</creatorcontrib><creatorcontrib>Martin, Friederike</creatorcontrib><creatorcontrib>Hillebrandt, Karl Herbert</creatorcontrib><creatorcontrib>Knitter, Sebastian</creatorcontrib><creatorcontrib>Schöning, Wenzel</creatorcontrib><creatorcontrib>Raschzok, Nathanael</creatorcontrib><creatorcontrib>Pratschke, Johann</creatorcontrib><creatorcontrib>Krenzien, Felix</creatorcontrib><collection>Springer Nature OA Free Journals</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Langenbeck's archives of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Butz, Frederike</au><au>Haase, Oliver</au><au>Martin, Friederike</au><au>Hillebrandt, Karl Herbert</au><au>Knitter, Sebastian</au><au>Schöning, Wenzel</au><au>Raschzok, Nathanael</au><au>Pratschke, Johann</au><au>Krenzien, Felix</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Short and longterm outcome of minimally invasive therapy of median arcuate ligament syndrome</atitle><jtitle>Langenbeck's archives of surgery</jtitle><stitle>Langenbecks Arch Surg</stitle><addtitle>Langenbecks Arch Surg</addtitle><date>2024-10-24</date><risdate>2024</risdate><volume>409</volume><issue>1</issue><spage>322</spage><pages>322-</pages><artnum>322</artnum><issn>1435-2451</issn><issn>1435-2443</issn><eissn>1435-2451</eissn><abstract>Purpose
Median arcuate ligament syndrome (MALS) is a rare disorder caused by compression of the celiac artery (CA) by the median arcuate ligament (MAL). Common symptoms include postprandial abdominal pain, diarrhea, and weight loss. While laparoscopic MAL division has long been considered the procedure of choice, robotic-assisted procedures have been increasingly used since their introduction. Aim of this study was to evaluate peri- and postoperative outcomes after minimally invasive MAL release.
Methods
A retrospective analysis of patients undergoing minimally invasive MAL release at the Department of Surgery, Charité - Universitätsmedizin Berlin, between 2014 and 2023 was performed.
Results
20 patients met the inclusion criteria and underwent either laparoscopic (
n
= 3) or robotic (
n
= 17) MAL release. Most common preoperative symptoms were postprandial abdominal pain (90%), weight loss (45%), diarrhea (30%), and nausea (25%). Comparing laparoscopic and robotic surgery, neither the median duration of surgery (minutes: 98 (90–290) vs. 125 (80–254);
p
= 0.765), the median length of hospital stay (days: 4 (3–4) vs. 5 (3–6);
p
= 0.179) and intraoperative blood loss (< 50 ml in both groups,
p
= 1.0) showed significant differences. Peak systolic velocity in the CA was significantly reduced postoperatively (cm/s: 320 (200–765) vs. 167 (100–500),
p
< 0.001). Postoperatively, 17 (85%) patients reported symptom improvement, while 4 (20%) patients had no symptom relief at last follow-up. In 3 cases, follow-up imaging showed evidence of respiratory-related CA stenosis.
Conclusion
Despite being complex and challenging procedures, laparoscopic and robotic-assisted MAL release are safe procedures with low risk of postoperative complications and good longterm outcomes.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>39446176</pmid><doi>10.1007/s00423-024-03511-9</doi><oa>free_for_read</oa></addata></record> |
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| ispartof | Langenbeck's archives of surgery, 2024-10, Vol.409 (1), p.322, Article 322 |
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| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_11502543 |
| source | MEDLINE; Springer Nature - Complete Springer Journals |
| subjects | Abdominal Surgery Adult Aged Cardiac Surgery Celiac Artery - surgery Female General Surgery Humans Laparoscopy - methods Length of Stay Male Median Arcuate Ligament Syndrome - surgery Medicine Medicine & Public Health Middle Aged Minimally Invasive Surgical Procedures - methods Retrospective Studies Robotic Surgical Procedures Thoracic Surgery Traumatic Surgery Treatment Outcome Vascular Surgery |
| title | Short and longterm outcome of minimally invasive therapy of median arcuate ligament syndrome |
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