Vascular Health and Risk Management (Mar 2022)
Laparoscopic Surgery for Median Arcuate Ligament Syndrome (MALS): A Prospective Cohort of 52 Patients
Abstract
Syed Sajid Hussain Kazmi,1,2 Nathkai Safi,1,2 Simen Tveten Berge,2,3 Marryam Kazmi,1,4 Jon Otto Sundhagen,1 Jonny Hisdal1,2 1Department of Vascular Surgery, Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Ullevål, Oslo, Norway; 2Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; 3Department of Vascular Surgery, Innlandet Hospital Trust, Hamar, Norway; 4Faculty 2, Poznan University of Medical Sciences, Poznan, PolandCorrespondence: Syed Sajid Hussain Kazmi, Department of Vascular Surgery, Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Ullevål, Kirkeveien 166, Oslo, 0450, Norway, Tel +47 92468309, Email [email protected]: The selection of patients with MALS for surgical treatment depends upon the reliability of the symptom interpretation and the diagnostic work-up. We aimed to follow up the results of the laparoscopic decompression of the patients with MALS.Patients and Methods: In a single-center, 52 consecutive MALS patients were followed-up, prospectively, after transperitoneal laparoscopic decompression. MALS was diagnosed with a computed tomography angiography (CTA) verified stenosis, ≥ 50% of the celiac artery (CA), and with duplex ultrasound, a peak systolic velocity (PSV) ≥ 2.0 m/s. Postoperative, CTA, and duplex ultrasound were performed, and the patients were followed-up at 3, 6, 12 months, and yearly after that.Results: Mean age of the patients was 47 ± 21 years, and 65% were females. The patients had a mean weight loss of 8.4 ± 7.2 kg. Fifty-one patients had the laparoscopic operation with a mean operation time of 102 ± 28 minutes. Forty-seven patients (90%) achieved relief from the symptoms either completely (67%) or partially (23%) at 3– 6 months of follow-up. Significant improvement in postoperative PSV was found compared to the preoperative values, p< 0.001. Five patients (10%) with no immediate effect of the operation, but two of them became free from symptoms during the mean study follow-up of 2.4 ± 2 years. Five patients (10%) had operative complications, including one trocar injury to the liver, one pneumothorax, and three cases of bleeding from the branches of CA. Two patients died of cancer disease during the study period. Only two patients (4%) had symptoms relapse, both later treated successfully.Conclusion: Laparoscopic transperitoneal decompression provides most of the patients a persistent relief from MALS symptoms.Keywords: median arcuate ligament syndrome, postprandial pain, laparoscopy, mesenteric ischemia
