Factors associated with successful median arcuate ligament release in an international, multi-institutional cohort

DeCarlo, Charles; Woo, Karen; Petersen, André S. van; Geelkerken, Robert H.; Chen, Alina; Yeh, Savannah L.; Kim, Gloria; Henke, Peter K.; Tracci, Margaret C.; Schneck, Matthew; Grotemeyer, D.; Meyer, Bernd; DeMartino, Randall R.; Wilkins, Parvathi B.; Iranmanesh, Sina; Rastogi, Vinamr; Aulivola, Bernadette; Korepta, Lindsey; Shutze, William P.; Jett, Kimble G.; Sorber, Rebecca; Abularrage, Christopher J.; Long, Graham W.; Bove, P; Miserlis, Dimitrios; Shih, Michael S. H.; Gupta, Renu; Loa, Jacky; Robinson, David A.; Gombert, Alexander; Doukas, Panagiotis G.; Caridi, Giovanni De; Benedetto, Filippo; Wittgen, Catherine M.; Smeds, Matthew R.; Sumpio, Bauer E.; Harris, Sean; Szeberin, Zoltan; Pomozi, Enikő; Stilo, Francesco; Montelione, Nunzio; Mouawad, Nicolas J.; Lawrence, Peter F.; Dua, Anahita

doi:10.1016/j.jvs.2022.10.022

Cited by 15 publications

(16 citation statements)

References 26 publications

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“…The patients from the cases presented fit the characteristics of MALS, but the syndrome remains mostly a diagnosis of exclusion. The patient typically presents with postprandial abdominal pain, weight loss, nausea, vomiting, and diarrhea, among other complaints[ 8 ]. From the physical examination, it is reported that in up to 35% of patients, an epigastric bruit can be heard on auscultation, but it certainly is not pathognomonic[ 6 ].…”

Section: Discussionmentioning

confidence: 99%

Median arcuate ligament syndrome often poses a diagnostic challenge: A literature review with a scope of our own experience

Giakoustidis¹,

Moschonas²,

Christodoulidis³

et al. 2023

World J Gastrointest Surg

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The median arcuate ligament syndrome (MALS) is recognized as a rare clinical entity, characterized by chronic post-prandial abdominal pain, nausea, vomiting, and unintentional weight loss. Due to its vague symptomatology, it is mainly regarded as a diagnosis of exclusion. Patients can often be misdiagnosed for several years before a correct diagnosis is established, also due to a medical team’s clinical suspicion. We present a case series of two patients who suffered from MALS and were treated successfully. The first patient is a 32-year-old woman, presenting with post-prandial abdominal pain and weight loss that have lasted for the past ten years. The second patient, a 50-year-old woman, presented with similar symptomatology, with the symptoms lasting for the last five years. Both cases were treated by laparoscopic division of the median arcuate ligament fibers, which alleviated extrinsic pressure from the celiac artery. Previous cases of MALS were retrieved from PubMed, to assemble a better diagnostic algorithm and propose a treatment method of choice. The literature review suggests an angiography with a respiratory variation protocol as the diagnostic modality of choice, along with the laparoscopic division of the median arcuate ligament fibers as the proposed treatment of choice.

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Section: Discussionmentioning

confidence: 99%

Median arcuate ligament syndrome often poses a diagnostic challenge: A literature review with a scope of our own experience

Giakoustidis¹,

Moschonas²,

Christodoulidis³

et al. 2023

World J Gastrointest Surg

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“…A study by DeCarlo et al compared outcomes between patients who underwent either open, laparoscopic, or robotic surgery for MALS. Their study showed that 49.3%, 62.4%, and 37.7% of patients had symptom relief at a three-year follow-up after undergoing open, laparoscopic, and robotic approaches to MALS surgery, respectively [ 33 ]. In a study by Shin et al that compared laparoscopic and robotic surgery for MALS, 50 patients underwent either of the two approaches to surgery.…”

Section: Reviewmentioning

confidence: 99%

Overview of Median Arcuate Ligament Syndrome: A Narrative Review

Upshaw,

Richey,

Ravi

et al. 2023

Cureus

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Median arcuate ligament syndrome (MALS) is a rare disorder caused primarily by compression of the celiac trunk by the median arcuate ligament (MAL). This disorder typically results in patients presenting with bloating, weight loss, nausea, vomiting, and abdominal pain. The MALS diagnosis is one of exclusion, as the disorder has no specific diagnostic criteria. Imaging modalities are often utilized to assist in making the diagnosis, such as ultrasound, computed tomography angiography (CTA), and magnetic resonance angiography (MRA). These imaging modalities typically reveal a stenosed celiac artery with post-stenotic dilation in patients. This disorder is usually treated by dividing the MAL, thus relieving the compression of the celiac artery. The surgery may be done through either an open approach or a minimally invasive approach, which can be either laparoscopic or robot-assisted. Most patients respond well to this treatment, though certain factors that predict a poorer response to treatment include elderly age, a history of alcohol abuse, and psychiatric illness.

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“…MALS is a vascular compression syndrome that results in chronic, reproducible epigastric abdominal pain, nausea, and weight loss and has radiographic evidence of celiac artery compression ( Harjola, 1963 ). Although there are surgical procedure to relieve the compression, symptoms attributable to the compression are improved in only 70–80% of patients ( Reilly et al, 1985 ; van Petersen et al, 2009 ; Tulloch et al, 2010 ; El-Hayek et al, 2013 ; Mak, 2017 ; DeCarlo et al, 2023 ). These suboptimal surgical outcomes reflect the poorly understood pathophysiology of the pain from the compression and result in many surgeons not offering the operation ( Szilagyi et al, 1972 ).…”

Section: Introductionmentioning

confidence: 99%

Median arcuate ligament syndrome: a cost analysis to determine the economic burden of a rarely diagnosed disease

Skelly,

Stiles-Shields,

Goldenthal

et al. 2024

Front. Psychol.

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BackgroundChronic abdominal pain (CAP) is a medical condition resulting in enormous economic burden and healthcare utilization costs. One understudied source of CAP is the median arcuate ligament syndrome (MALS). MALS is often not diagnosed and treated for a variety of reasons, including the fact that MALS is highly comorbid with psychological symptoms and psychiatric disorders similar to CAP. To better inform future work on the study of MALS, we undertook a pilot study to estimate the economic impact and public health burden of this condition. We hypothesized that MALS imposes a significant public health burden.MethodsPediatric and adult patients enrolled in a prospective study undergoing multidisciplinary evaluation and treatment for MALS at a tertiary care facility were invited to participate in a brief self-report survey, the Direct and Indirect Medical Care Impact of MALS Form, to capture health care resources including procedures, surgeries, health care visits, and absenteeism (school and work). To estimate costs from the Direct and Indirect Medical Care Impact of MALS Form, the medical care usage data self-reported by patients were converted to dollar value utilizing FSC-93 billing data and corresponding current procedural terminology (CPT) codes for procedures and provider visits one year prior to surgery and then following surgery. Descriptive analyses were conducted to characterize the sample in terms of demographics and reported absences from school and work.ResultsOne hundred and nineteen patients (mean age = 30.9 ± 13.0) completed the questionnaires, yielding a 57% response rate. 82.4% (n = 98) of the participants were female and 90.8% (n = 108) were non-Hispanic/Latine white. The mean and median surgical follow-up periods were 5.3 and 5.4 years, respectively. Overall, median cost of provider and ancillary healthcare provider visits for each patient was (US)$19,119 including the pre-operative and post-operative visits. The mean cost for providers alone was (US)$28,908. Wilcoxon signed-ranks tests indicated that the postoperative missed number of days of school were significantly lower than the pre-surgical number of missed school days (Z = −3.36, p = 0.001). Similarly, there were significantly less missed work-days following surgery than before for the entire sample (Z = −2.86, p = 0.004).ConclusionMedian arcuate ligament syndrome imposes a large economic burden on patients and the healthcare system. The current findings, although reflective of a homogenous population, are adding to a growing body of literature suggesting that healthcare disparities play a role in the low rates of diagnosis and treatment of MALS.

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Factors associated with successful median arcuate ligament release in an international, multi-institutional cohort

Cited by 15 publications

References 26 publications

Median arcuate ligament syndrome often poses a diagnostic challenge: A literature review with a scope of our own experience

Median arcuate ligament syndrome often poses a diagnostic challenge: A literature review with a scope of our own experience

Overview of Median Arcuate Ligament Syndrome: A Narrative Review

Median arcuate ligament syndrome: a cost analysis to determine the economic burden of a rarely diagnosed disease

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