Open and laparoscopic treatment of median arcuate ligament syndrome

BackgroundMedian arcuate ligament syndrome (MALS) is a syndrome associated with chronic abdominal pain and radiographic evidence of celiac artery compression. We compared the evidence for both open and laparoscopic treatment of patients with MALS.MethodsWe reviewed the English-language literature between 1963 and 2012. Presenting symptoms, clinical improvement, operative details, and intraoperative and postoperative complications were noted.ResultsA total of 400 patients underwent surgical (open and laparoscopic) treatment for MALS. Three hundred thirty-nine patients reported immediate postoperative symptom relief (85%). Late recurrence of symptoms was reported in 19 patients in the open group (6.8%) and seven patients in the laparoscopic group (5.7%). Eleven out of 121 patients (9.1%) in the laparoscopic group required open conversion secondary to bleeding.ConclusionsThe available evidence demonstrates that both laparoscopic and open ligament release, celiac ganglionectomy, and celiac artery revascularization may provide sustained symptom relief in the majority of patients diagnosed with MALS. The role of arterial revascularization following ligament release remains unclear. The rate of open conversion with the laparoscopic approach is high, but no perioperative deaths have been reported.