Prognostic factors for the long term outcome after surgical celiac artery decompression in patients with median arcuate ligament syndrome (MALS)
EAES Academy. Woestemeier A. 07/05/22; 366527; P270
Dr. Anna Woestemeier
Contributions
Contributions
Abstract
Background
Surgical treatment of median arcuate ligament syndrome (MALS) aims to restore normal celiac blood flow by laparoscopic celiac artery decompression. However surgical success rates vary widely between patients, therefore adequate selection of patients is key to improve surgical outcome. So far, no specific parameters or imaging results were found to be predictive of this response.
The objective of this study was to identify preclinical parameters that help to distinguish patients that would benefit from surgical release can predict clinical response to laparoscopic release of the MAL in patients with celiac artery compression.
Methods
20 patients diagnosed with MALS were included in this study and underwent laparoscopic MAL release between 2016 and 2021. The patients' preoperative and postoperative symptoms, patients' demographics, duplex abdominal ultrasonography (DUS) and CT angiography (CTA) findings were reviewed. Mann-Whitney-U-Test was used to identify correlation between patient or imaging variables and clinical outcomes.
Results
60% of patients had a relief of their symptoms and simultaneous decrease of analgetic use after laparoscopic MAL release, while 8 patients (40%) had persistent symptoms. Neither sex, BMI, age, operation time nor the operation technique correlated significantly with symptom relief. However, mast cell activation syndrome correlated significantly (p=0.04) with persistent symptoms after operation.
Conclusions
Overall, laparoscopic MAL release is an effective treatment for MALS and can provide immediate symptomatic relief. However, no specific imaging finding of stenosis was able to predict response to treatment. Our data show a correlation between persistent symptoms and a co-existing mast cell activation syndrome, suggesting that MACS symptoms might be interpreted as MALS symptoms in the presence of celiac artery stenosis and surgical treatment should be evaluated carefully. Overall, selection of patients who are most likely to respond to surgical MAL release may best be accomplished through a constellation of clinical and imaging findings with an interdisciplinary team of gastroenterologists, radiologists and surgeons.
Surgical treatment of median arcuate ligament syndrome (MALS) aims to restore normal celiac blood flow by laparoscopic celiac artery decompression. However surgical success rates vary widely between patients, therefore adequate selection of patients is key to improve surgical outcome. So far, no specific parameters or imaging results were found to be predictive of this response.
The objective of this study was to identify preclinical parameters that help to distinguish patients that would benefit from surgical release can predict clinical response to laparoscopic release of the MAL in patients with celiac artery compression.
Methods
20 patients diagnosed with MALS were included in this study and underwent laparoscopic MAL release between 2016 and 2021. The patients' preoperative and postoperative symptoms, patients' demographics, duplex abdominal ultrasonography (DUS) and CT angiography (CTA) findings were reviewed. Mann-Whitney-U-Test was used to identify correlation between patient or imaging variables and clinical outcomes.
Results
60% of patients had a relief of their symptoms and simultaneous decrease of analgetic use after laparoscopic MAL release, while 8 patients (40%) had persistent symptoms. Neither sex, BMI, age, operation time nor the operation technique correlated significantly with symptom relief. However, mast cell activation syndrome correlated significantly (p=0.04) with persistent symptoms after operation.
Conclusions
Overall, laparoscopic MAL release is an effective treatment for MALS and can provide immediate symptomatic relief. However, no specific imaging finding of stenosis was able to predict response to treatment. Our data show a correlation between persistent symptoms and a co-existing mast cell activation syndrome, suggesting that MACS symptoms might be interpreted as MALS symptoms in the presence of celiac artery stenosis and surgical treatment should be evaluated carefully. Overall, selection of patients who are most likely to respond to surgical MAL release may best be accomplished through a constellation of clinical and imaging findings with an interdisciplinary team of gastroenterologists, radiologists and surgeons.
Background
Surgical treatment of median arcuate ligament syndrome (MALS) aims to restore normal celiac blood flow by laparoscopic celiac artery decompression. However surgical success rates vary widely between patients, therefore adequate selection of patients is key to improve surgical outcome. So far, no specific parameters or imaging results were found to be predictive of this response.
The objective of this study was to identify preclinical parameters that help to distinguish patients that would benefit from surgical release can predict clinical response to laparoscopic release of the MAL in patients with celiac artery compression.
Methods
20 patients diagnosed with MALS were included in this study and underwent laparoscopic MAL release between 2016 and 2021. The patients' preoperative and postoperative symptoms, patients' demographics, duplex abdominal ultrasonography (DUS) and CT angiography (CTA) findings were reviewed. Mann-Whitney-U-Test was used to identify correlation between patient or imaging variables and clinical outcomes.
Results
60% of patients had a relief of their symptoms and simultaneous decrease of analgetic use after laparoscopic MAL release, while 8 patients (40%) had persistent symptoms. Neither sex, BMI, age, operation time nor the operation technique correlated significantly with symptom relief. However, mast cell activation syndrome correlated significantly (p=0.04) with persistent symptoms after operation.
Conclusions
Overall, laparoscopic MAL release is an effective treatment for MALS and can provide immediate symptomatic relief. However, no specific imaging finding of stenosis was able to predict response to treatment. Our data show a correlation between persistent symptoms and a co-existing mast cell activation syndrome, suggesting that MACS symptoms might be interpreted as MALS symptoms in the presence of celiac artery stenosis and surgical treatment should be evaluated carefully. Overall, selection of patients who are most likely to respond to surgical MAL release may best be accomplished through a constellation of clinical and imaging findings with an interdisciplinary team of gastroenterologists, radiologists and surgeons.
Surgical treatment of median arcuate ligament syndrome (MALS) aims to restore normal celiac blood flow by laparoscopic celiac artery decompression. However surgical success rates vary widely between patients, therefore adequate selection of patients is key to improve surgical outcome. So far, no specific parameters or imaging results were found to be predictive of this response.
The objective of this study was to identify preclinical parameters that help to distinguish patients that would benefit from surgical release can predict clinical response to laparoscopic release of the MAL in patients with celiac artery compression.
Methods
20 patients diagnosed with MALS were included in this study and underwent laparoscopic MAL release between 2016 and 2021. The patients' preoperative and postoperative symptoms, patients' demographics, duplex abdominal ultrasonography (DUS) and CT angiography (CTA) findings were reviewed. Mann-Whitney-U-Test was used to identify correlation between patient or imaging variables and clinical outcomes.
Results
60% of patients had a relief of their symptoms and simultaneous decrease of analgetic use after laparoscopic MAL release, while 8 patients (40%) had persistent symptoms. Neither sex, BMI, age, operation time nor the operation technique correlated significantly with symptom relief. However, mast cell activation syndrome correlated significantly (p=0.04) with persistent symptoms after operation.
Conclusions
Overall, laparoscopic MAL release is an effective treatment for MALS and can provide immediate symptomatic relief. However, no specific imaging finding of stenosis was able to predict response to treatment. Our data show a correlation between persistent symptoms and a co-existing mast cell activation syndrome, suggesting that MACS symptoms might be interpreted as MALS symptoms in the presence of celiac artery stenosis and surgical treatment should be evaluated carefully. Overall, selection of patients who are most likely to respond to surgical MAL release may best be accomplished through a constellation of clinical and imaging findings with an interdisciplinary team of gastroenterologists, radiologists and surgeons.
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