title: Laparoscopic versus robot-assisted surgery for median arcuate ligament syndrome.
abstract: BACKGROUND
  Median arcuate ligament syndrome (MALS) is an uncommon disorder characterized by postprandial abdominal pain, weight loss, and vomiting related to the compression of the celiac artery by the median arcuate ligament. This syndrome has been classically treated with an open surgical approach. More recently, laparoscopic and robotic approaches have been used. We present our outcomes with laparoscopic and robot-assisted treatment of MALS.
  
  
  METHODS
  We performed a retrospective review of all patients treated for MALS from March 2006 to August 2012 at a single institution.
  
  
  RESULTS
  A total of 16 patients with MALS were treated: 12 patients via a laparoscopic approach and 4 patients via a robot-assisted approach. Patient characteristics and comorbidities were similar between groups. We experienced no intraoperative or perioperative conversions, complications, or deaths. The mean operative time for the laparoscopic approach was significantly shorter than for the robotic approach (101.7 vs. 145.8 min; P = 0.02). However, we found no significant difference in length of hospital stay (1.7 vs. 1.3 days, P = 0.23). The mean length of follow-up for laparoscopically treated patients was 22.2 months and for robotically treated patients it was 20 months. Eight patients (67 %) in the laparoscopic group and two patients (50 %) in the robotic group had full resolution of their abdominal pain. Three patients in the laparoscopic group and two patients in the robotic group ceased chronic narcotic use after surgery.
  
  
  CONCLUSIONS
  Both laparoscopic and robotic approaches to MALS treatment can be performed with minimal morbidity and mortality. The laparoscopic approach was associated with a significantly shorter operative time. While innovative, the true advantages to robot-assisted MALS surgery are yet to be seen.
authors.affiliation: Department of Surgery, Ochsner Clinic Foundation, 1514 Jefferson Hwy, New Orleans, LA, 70121, USA, mdo@ochsner.org.
authors.forename: Michael V
authors.initials: MV
authors.lastname: Do
authors.forename: Taylor A
authors.initials: TA
authors.lastname: Smith
authors.forename: Hernan A
authors.initials: HA
authors.lastname: Bazan
authors.forename: W C
authors.initials: WC
authors.lastname: Sternbergh
authors.forename: Abbas E
authors.initials: AE
authors.lastname: Abbas
authors.forename: William S
authors.initials: WS
authors.lastname: Richardson
mesh_terms: D002445:Celiac Artery / Q000002:abnormalities* / Q000601:surgery; D003251:Constriction, Pathologic / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay / Q000706:statistics & numerical data; D008022:Ligaments / Q000601:surgery*; D008297:Male; D000074742:Median Arcuate Ligament Syndrome; D008875:Middle Aged; D061646:Operative Time; D011300:Preoperative Care; D012189:Retrospective Studies; D012371:Robotics / Q000379:methods*; D016896:Treatment Outcome