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OBJECTIVES:
Median Arcuate Ligament syndrome (MALS) is considered an uncommon entity the very existence of which has been questioned. We sought to determine whether patients treated at our institution for MALS had relief of their symptoms both in the short term, after one year and what procedural and other factors may have contributed to these outcomes.
METHODS:
Patients treated for MALS with Median Arcuate Ligament Release (MALR) between 2011-2015 were retrospectively reviewed. Resolution of symptoms and re-intervention were the primary endpoints. Clinic notes, operative reports and telephone calls to the patients were used. Via telephone interview, the SF-12 questionnaire, a validated survey which is a measure of perceived health that describes the degree of general physical health status was administered. Additionally, four questions specific to their preoperative and postoperative pain were used to assess patient perception of their previous and current pain status.
RESULTS:
Thirty four patients, 24 female and 10 male, ages 16 to 81 years old, were treated for MALS. All of the patients had chronic epigastric abdominal pain, 19 of which had associated postprandial pain or bloating. 29 of the 34 had extensive prior GI workup that was either unrevealing or unresponsive to medical management. All patients had a median arcuate ligament release (MALR) performed. Open MALR was performed in 97% (33/34) patients. One patient had an attempted laparoscopic release, which was converted to open. Celiac plexus neurolysis was performed in 88% (30/34) of patients. Vascular intervention or reconstruction was not required in 79% (27/34) patients. Follow-up ranged from 2 weeks to 2.5 years. There was a resolution of symptoms in 89.5% (28/34) of patients postoperatively upon retrospective chart review. 6% (2/34) required re-intervention. Eleven of 18 patients with more than one year of follow-up were contacted and completed the SF- 12 questionnaire. Eight of the 11 patients (73%) remained free of symptoms at one year while 3 had a recurrence of their original pain.
CONCLUSIONS:
The incidence of MALS may be more common than was originally thought and the diagnosis should be more readily considered in those patients with a history of chronic abdominal pain and a negative GI workup. Following MALR with concomitant celiac plexus neurolysis, relief of pain was achieved in most patients followed for more than one year.