David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA.
Division of Vascular and Endovascular Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA.
Ann Vasc Surg. 2023 Aug;94:296-300. doi: 10.1016/j.avsg.2023.02.030. Epub 2023 Mar 15.
Median arcuate ligament syndrome (MALS) is an uncommon diagnosis that is often associated with variable clinical presentation and inconsistent response to treatment. Due to the nature of MALS, the optimal treatment modality and predictors of outcomes remain unclear.
A retrospective review was performed of all median arcuate ligament release (MALR) procedures at a single academic institution between 2000 and 2020. Variables examined included patient demographics, symptom characteristics, operative technique (open, robotic, laparoscopic), patient symptoms before release, symptom relief within 1 year, and recurrence of symptoms between release and last clinical follow-up.
During the study period, 47 patients (75% female, mean age 42.1 years) underwent MALR with 19 (36%) robotic, 18 (34%) open, 14 (26%) laparoscopic, and 2 (4%) laparoscopic converted to open procedures. Abdominal pain, weight loss, and nausea and vomiting were the most common symptoms. Postoperatively, 19 (40%) had complete symptom relief within 1 year, 18 (38%) had partial relief, and 10 (21%) had no symptom improvement. 6 were excluded due to loss of follow-up. Laparoscopic and open procedures had the highest rate of complete symptom relief by year 1 with 7 (58%) and 8 (50%) respectively. Twenty-one (57%) patients had recurrence with the greatest rate of recurrence seen among laparoscopic (80%), compared to robotic (57%) and open (38%). Patients reporting a weight loss of 20 pounds or more before surgery were more likely to have partial or complete symptom relief after 1 year compared to those reporting less than 20-pound weight loss (92% vs. 64%). Furthermore, 84% of patients younger than 60 years old reported partial or complete symptom relief compared to only 56% of those older than 60.
MALS continues to be a rare disorder with widely variable surgical outcomes, requiring further study. While our patients presented with several gastrointestinal symptoms, the most common was postprandial pain. Our center employed laparoscopic, open, and robotic operative techniques with varying success rates, in terms of symptom relief and recurrence. Consistent with current literature, our study found greater surgical success among patients younger than 60 years regardless of operative technique. This suggests the need for better predictors to determine which patients are the most likely to have complete or prolonged remission of symptoms following MALR.
中位弓状韧带综合征（MALS）是一种不常见的诊断，常伴有多变的临床表现和治疗反应不一致。由于 MALS 的性质，最佳治疗方式和结局预测因素仍不清楚。
对 2000 年至 2020 年间在一家学术机构进行的所有中位弓状韧带松解术（MALR）进行回顾性分析。检查的变量包括患者人口统计学、症状特征、手术技术（开放、机器人、腹腔镜）、松解前的患者症状、1 年内的症状缓解情况以及松解和最后一次临床随访之间症状的复发情况。
在研究期间，47 名患者（75%为女性，平均年龄 42.1 岁）接受了 MALR 治疗，其中 19 例（36%）为机器人手术，18 例（34%）为开放手术，14 例（26%）为腹腔镜手术，2 例（4%）为腹腔镜转为开放手术。腹痛、体重减轻、恶心和呕吐是最常见的症状。术后 1 年内，19 例（40%）完全缓解，18 例（38%）部分缓解，10 例（21%）无症状改善。6 例因失访而被排除。腹腔镜和开放手术在第 1 年完全缓解症状的比例最高，分别为 7（58%）和 8（50%）。21 例（57%）患者复发，其中腹腔镜（80%）的复发率最高，而机器人（57%）和开放（38%）的复发率较低。与体重减轻 20 磅或以上的患者相比，体重减轻不足 20 磅的患者在 1 年后出现部分或完全症状缓解的可能性更小（92%比 64%）。此外，84%的 60 岁以下患者报告部分或完全症状缓解，而 60 岁以上患者只有 56%报告部分或完全症状缓解。
MALS 仍然是一种罕见的疾病，手术结果差异很大，需要进一步研究。尽管我们的患者表现出多种胃肠道症状，但最常见的是餐后疼痛。我们中心采用了腹腔镜、开放和机器人手术技术，其在缓解症状和复发方面的成功率各不相同。与目前的文献一致，我们的研究发现，60 岁以下患者的手术成功率更高，无论手术技术如何。这表明需要更好的预测指标来确定哪些患者最有可能在 MALR 后完全或长期缓解症状。
