Balancing operative risk and symptom relief: Outcomes of open versus laparoscopic release for median arcuate ligament...

Median arcuate ligament syndrome is a rare condition involving compression of the celiac artery and/or celiac plexus by the median arcuate ligament, often causing chronic gastrointestinal symptoms. Surgical decompression via median arcuate ligament release (MALR) is the definitive treatment; however, the optimal approach remains debated.

We retrospectively reviewed 271 patients who underwent MALR (120 open, 151 laparoscopic) at our institution between 2001 and 2024.

Patients in the laparoscopic group more frequently completed diagnostic evaluations including dynamic duplex ultrasound scanning (76.8% vs 57.5%, P < .001), provocative mesenteric angiography (35.8% vs 11.7%, P < .001), and celiac plexus block (74.2% vs 46.7%, P < .001). Conversion to open surgery occurred in 4.6% of laparoscopic cases. Intraoperative interventions were more common in open cases (17.5% vs 2.0%, P < .001). The open group experienced higher rates of postoperative ileus (17.5% vs 2.0%, P < .001) and longer hospital stays (4.6 ± 1.7 vs 1.7 ± 1.3 days, P < .001). However, open MALR was associated with greater improvement in pain (84.2% vs 71.5%, P = .014) and nausea (89.7% vs 78.5%, P = .034). A multivariable logistic regression for nausea improvement demonstrated a significant inverse association with body mass index, indicating that higher body mass index was associated with lower odds of symptom improvement (odds ratio: 0.87 per 1 kg/m² increase; 95% confidence interval: 0.80-0.95; P = .0015).

Both open and laparoscopic MALR provide symptom relief in patients with median arcuate ligament syndrome. Open surgery showed a trend toward greater improvement in pain and nausea (particularly nausea) but at the cost of higher morbidity, highlighting the need for careful patient-specific approach selection.