A nationwide analysis of median arcuate ligament release between 2010 and 2020: a NSQIP Study

Romero-Vélez, Gustavo; Barajas‐Gamboa, Juan S.; Pantoja, Juan Pablo; Corcelles, Ricard; Rodriguez, John; Navarrete, Salvador; Park, Woosup M.; Kroh, Mathew

doi:10.1007/s00464-022-09431-3

Cited by 11 publications

(10 citation statements)

References 22 publications

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“…A large cross-sectional study analyzing the trend of operative management of MALS from 2010 to 2022 showed that out of 33 951 cases identified in the last 12 years, only 2.4% had operative management, with a shift toward the laparoscopic approach due to minimal postoperative complications and decreased hospital stay. In properly selected cases, symptom relief has been reported at 96% postoperatively ( 11 , 12 ).…”

Section: Discussionmentioning

confidence: 99%

Progressive Dysphagia and Chronic Abdominal Pain From Vascular Anomalies: A Case Report and Literature Review

Agarwal¹,

Thompson²,

Barr³

et al. 2023

JPGN Reports

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Median arcuate ligament syndrome and symptomatic aberrant right subclavian artery are uncommon in the pediatric population and are rarely found in the same individual. We present the case of a teenager with 2 rare vascular anomalies leading to chronic postprandial abdominal pain, dysphagia, and weight loss. The purpose of this case report is to raise awareness about these rare anomalies and their presentations in the pediatric population.

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Section: Discussionmentioning

confidence: 99%

Progressive Dysphagia and Chronic Abdominal Pain From Vascular Anomalies: A Case Report and Literature Review

Agarwal¹,

Thompson²,

Barr³

et al. 2023

JPGN Reports

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“…20 The mean LOS was notably shorter compared to findings in another study by Kroh et al (2.3 ± 3.2 d). 12 This difference can be attributed to the adoption of minimally invasive surgical techniques, reduced postoperative opioid use, and better pain management following minimal surgical incisions.…”

Section: Discussionmentioning

confidence: 99%

“…In 2000, Roayaie first described the laparoscopic MALR, marking a pivotal moment in surgical approaches for MALS. Subsequently, this minimally invasive technique gained widespread adoption among surgeons due to its recognized advantages, including avoiding midline incisions, shorter hospital stays, reduced postoperative pain, lower complication rates, and earlier resumption of oral intake 12 …”

Section: Discussionmentioning

confidence: 99%

Laparoscopic Median Arcuate Ligament Release: Surgical Technique and Clinical Outcomes

Belluzzi,

Salame,

Abi Mosleh

et al. 2023

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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Background: Median arcuate ligament syndrome (MALS) is characterized by a constellation of symptoms related to the compression of the celiac artery trunk. Laparoscopic release of the ligament has demonstrated its effectiveness in alleviating these symptoms while showing lower postoperative complication rates, reduced hospital stays, and improved clinical outcomes. This study describes a single institution’s experience with this procedure and reports on the preoperative assessment, surgical technique, and clinical outcomes of patients with MALS. Methods: We performed a retrospective chart review of all patients who underwent a primary laparoscopic MAL release (MALR) at a single high-volume academic institution from June 2021 to July 2023. Patient demographics, preoperative assessment, postoperative complications, and resolution of preoperative symptoms data were collected. Results: A total of 30 patients underwent laparoscopic MALR, with 76.7% being female and a mean age of 33.4±16.3 years. The most common presenting symptom was postprandial epigastric pain (100%), followed by abdominal pain and nausea (83.3%), among others. The preoperative evaluation for all patients included a duplex mesenteric doppler and CT angiogram during inspiration and expiration and 3D reconstruction. Successful laparoscopic decompression of the celiac artery was achieved in 96.6% of cases, with only one conversion to an open procedure. There was only one reported early (<30 d postoperatively) complication with no subsequent late complications or mortality. None of the patients required reintervention or reoperation. Only 1 patient required postoperative celiac plexus/splanchnic block injection to alleviate pain. Conclusions: MALS can be effectively and safely managed using a laparoscopic approach when performed by an experienced minimally invasive surgeon. Further studies with longer follow-ups are needed to confirm the long-term effectiveness of this technique.

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“…10,11 Even with prudent patient selection for the procedure, this surgery is complex and requires aggressive pain management and control. 12 As widely reported, many MALS patients are considered chronic pain patients, and require effective pain management before, during, and after surgery to reduce acute postoperative pain. 13 A pain management program at our hospital was implemented in 2017 to formulate and execute a plan for perioperative pain management, including education, presentation of options, and discussion of expectations.…”

Section: Introductionmentioning

confidence: 98%

Evaluation of a pain management program for patients with median arcuate ligament syndrome

et al. 2023

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Objectives: Median arcuate ligament syndrome is a complex disorder potentially caused by variation in the position of the median arcuate ligament. Symptomology involves chronic abdominal pain, nausea, and malnourishment. Pain management modalities and short-term outcomes for patients undergoing operative surgery for median arcuate ligament syndrome have yet to be fully evaluated. Our hospital implemented a pain management consultation program in 2017 focused on perioperative pain management. The objective of this study is to assess if the introduction of a pain management consultation program concurrent with median arcuate ligament syndrome surgery impacts patient outcomes and post-operative pain management strategies in these patients. Methods: De-identified data was collected retrospectively from our hospital’s electronic medical records system, identifying median arcuate ligament syndrome patients and using International Classification of Diseases (ICD) and Current Procedural Terminology (CPT) codes from September 2017 to August 2021. Patients were grouped into the “consultation” cohort if they had scheduled and attended a pre-operative pain consultation. Pre-operative and discharge medications, pain scores, and demographics were collected to evaluate if the initiative impacted outcomes. Results: Median arcuate ligament syndrome patients who had a pre-operative pain management consultation had higher rates of pre-operative opioid (35.5%; p = 0.01) and non-opioid use (60.7%; p < 0.001). Patients without a pre-operative consultation that did not use opioids pre-operatively were more likely to be discharged on one or more opioids. Differences were also found for psychiatric medication at discharge ( p < 0.001) with patients receiving pain consultation indicating higher percentages of use. Conclusion: Special consideration on prescribing pain medication should be part of discharge planning for median arcuate ligament syndrome patients. Addition of a pain management consultation can aid in these decisions.

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A nationwide analysis of median arcuate ligament release between 2010 and 2020: a NSQIP Study

Cited by 11 publications

References 22 publications

Progressive Dysphagia and Chronic Abdominal Pain From Vascular Anomalies: A Case Report and Literature Review

Progressive Dysphagia and Chronic Abdominal Pain From Vascular Anomalies: A Case Report and Literature Review

Laparoscopic Median Arcuate Ligament Release: Surgical Technique and Clinical Outcomes

Evaluation of a pain management program for patients with median arcuate ligament syndrome

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