ABSTRACT
Median arcuate ligament syndrome (MALS) is uncommon and often difficult to diagnose due to the vague presenting symptoms of abdominal pain, weight loss, and early satiety. Here, we report the case of a 63-year-old man who was successfully treated with laparoscopic median arcuate ligament release. Computed tomography (CT) of the abdomen and pelvis performed preoperatively demonstrated compression of the celiac artery with post-stenotic dilatation consistent with MALS. Subsequently, laparoscopic median arcuate ligament release was performed without any complications. Postoperatively, the patient reported resolution of abdominal pain with increased appetite and weight gain. Nonspecific abdominal pain and weight loss may raise concern for malignancy, but MALS should also be considered in the differential diagnoses. Diagnosis can be confirmed with CT and/or angiography. Median arcuate ligament release results in partial if not complete resolution of symptoms due to decompression of the celiac artery as well as division of the overlying celiac plexus.
ABSTRACT
BACKGROUND: Limited evidence exists to which operation gives best long-term outcomes for gastro-oesophageal reflux disease. This study aimed to assess long-term symptomatic outcome and satisfaction following laparoscopic anterior (LA) or Nissen fundoplication in a specialist upper gastrointestinal unit. METHODS: Patients who underwent primary LA or Nissen (LN) fundoplication between May 1994 and June 2010 were identified from a prospectively collected database. DeMeester, modified DeMeester, 'Gastrointestinal Symptom Rating Scale' scores and patient satisfaction were assessed by questionnaire. RESULTS: A total of 387 patients underwent surgery and 246 patients (65%) completed questionnaires, with 181 LA patients and 65 LN patients. Median follow-up was 83 months for LA and 179 months for LN (P < 0.001). A total of 218/245 (89%) reported major improvement in symptoms and 27 (11%) reported poor outcomes. There was no differences between LA and LN for symptom scores at short (<5 years) or long-term follow-up (>5 years). Women reported significantly higher DeMeester scores and lower satisfaction (P = 0.012). One hundred and eighteen (48%) patients were taking proton pump inhibitors (PPI) at follow-up despite high satisfaction rates. CONCLUSION: LA and LN have similar long-term results with patients reporting high satisfaction levels. Women reported more symptoms and less satisfaction than men. Despite high satisfaction rates a high percentage of patients take PPIs.
