Quest for Successful Outcome Determinants of Video Assisted Retroperitoneal Coeliac Artery Release in Patients with Median Arcuate Ligament Syndrome: Retrospective Single Centre Study Based on Prospectively Collected Data

Objective:

To diagnose median arcuate ligament syndrome (MALS), in the absence of a validated and easily available function test, evaluation of the classic chronic mesenteric ischaemia (CMI) symptoms is the only tool available. The effectiveness of video assisted retroperitoneal coeliac artery release (vaCAR) is disputed. Reported outcomes are diverse and guidelines allow room for interpretation. This retrospective cohort study, based on prospectively collected data, aimed to find determinants associated with a successful outcome of vaCAR, with the goal of improving patient selection. Secondarily, it sought to determine the effect of vaCAR on symptoms and quality of life (QoL).

Methods:

Questionnaires at intake and follow up of MALS patients diagnosed between 2014 and 2021 who underwent vaCAR were collected. Patients were selected by a multidisciplinary mesenteric ischaemia expert team based on current CMI guidelines. A successful outcome of vaCAR was defined as ≥ 50% reduction in abdominal pain on a visual analogue scale and or when patients reported "a lot less pain" on a five point Likert scale. Pre-intervention characteristics of patients with a successful outcome were compared with those with an unsuccessful outcome. The effect of vaCAR was evaluated by comparing symptoms and QoL before and after vaCAR.

Results:

Ninety-eight patients treated for MALS with vaCAR were included. No statistically significant differences in patient characteristics were found between the successful and unsuccessful outcome groups. Two thirds of patients had improvement in abdominal pain after vaCAR according to the definition. Furthermore, vaCAR led to statistically significant improvements in all reported symptoms, including a decrease in abdominal pain (79%) and improved QoL (77%).

Conclusion:

In this cohort, no characteristic could predict a successful outcome of vaCAR. Nevertheless, statistically significant and clinically relevant symptom reduction and improved QoL were measured after vaCAR, substantiating that vaCAR could be an effective treatment for MALS patients.