Psychological Factors and Outcomes in the Surgical Treatment of Pediatric Patients With Median Arcuate Ligament Syndrome

Abstract

Comorbid psychological conditions are common in pediatric patients with MALS, and are maintained following surgery. While surgery improved pain and QOL, the need for presurgical psychological interventions for MALS is implicated.

The impact of psychiatric comorbidities on patient-reported surgical outcomes in adults treated for the median arcuate ligament syndrome

“…This study supports previous findings that surgery improves QOL for patients with MALS, 1,5,41 specifically in an adult population. In addition, this study provides further evidence of the relevance of psychiatric comorbidities in patients with MALS.…”

“…In addition, this study provides further evidence of the relevance of psychiatric comorbidities in patients with MALS. 19,41 The presence, persistence, and predictive impact of presurgical psychiatric disorders in adult patients with MALS indicate a need to support these patients from a biopsychosocial perspective with a comprehensive multidisciplinary program, including psychological services. There is no evidence to suggest that the changes in QOL from surgery improve all psychological symptoms.…”

Targeting Coping to Improve Surgical Outcomes in Pediatric Patients With Median Arcuate Ligament Syndrome: Feasibility Study

“…Indeed, while the majority of patients report symptom relief and increased QOL following surgical intervention, about one third continue to experience CAP (Mak et al, 2013;Pather et al, 2020). Additionally, about half of pediatric patients who undergo surgery for MALS meet criteria for at least one psychiatric disorder, including depression and/or anxiety; these psychiatric symptoms do not appear to improve with surgical intervention (Mak et al, 2016;Stiles-Shields et al, 2018). Further, pre-surgical psychiatric diagnoses have been found to significantly predict lower post-surgical QOL for both pediatric and adult samples with MALS (Skelly et al, 2018;Stiles-Shields et al, 2018).…”

“…Due to the complexities and comorbidities of MALS, some teams have adopted an interdisciplinary assessment and treatment approach, consisting of a general pediatric surgeon, vascular surgeon, pain specialist, and psychologist (Stiles-Shields et al, 2018). This model is not universal across treatment settings.…”

“…However, an interdisciplinary approach that includes a presurgical psychological evaluation has initial patient support as a beneficial practice (Stiles-Shields et al, 2021) and increases the likelihood of the identification of psychiatric comorbidities. While a pre-surgical psychological intervention is not always required to move forward with a MALS surgery, even when comorbidities are identified, it is possible that increasing the coping strategies of treatment-seeking pediatric patients with MALS may impact their post-surgical outcomes (Stiles-Shields et al, 2018). However, to date, there have been no psychological interventions designed specifically for this population.…”