Minimally invasive surgery for median arcuate ligament syndrome: Clinical outcomes and recurrence patterns

Median arcuate ligament syndrome is a rare condition characterized by celiac artery compression, leading to abdominal symptoms. Its variability in symptom severity and treatment responses presents challenges for clinicians, making accurate diagnosis and effective management critical for patient outcomes. The goal was to assess clinical features, diagnostic approaches, and outcomes following minimally invasive median arcuate ligament release for median arcuate ligament syndrome.

A retrospective analysis was conducted on patients treated for median arcuate ligament syndrome within our health care system between March 2015 and May 2021. Data including demographics, presenting symptoms, treatment modalities, surgical outcomes, and follow-up results were collected and analyzed.

A total of 162 patients (130 female) with median arcuate ligament syndrome underwent minimally invasive median arcuate ligament release. Median age was 38.5, with a mean body mass index of 25.1. Common presenting symptoms included abdominal pain, postprandial pain, nausea/vomiting, and weight loss. Median duration of symptoms was 24 months. Preoperative celiac ganglion block was performed in 126 patients (77.7%). Median operative time was 77 minutes (range 32-287), and conversion rate to open surgery of 4.3%, primarily due to bleeding. Median hospital stay was 2 days. At 13-month median follow-up, 88.7% of patients reported partial or complete resolution of symptoms following surgery. However, symptom recurrence occurred in 73 patients (45%), frequently within 3 months postoperatively. Only 34 cases (28.8%) showed evidence of recurrence on postoperative imaging.

Minimally invasive surgery for median arcuate ligament syndrome offers favorable outcomes in terms of symptom relief, with most patients experiencing initial improvement. However, symptom recurrence remains a challenge, often without evident radiographic evidence.