Zespół więzadła łukowatego środkowego (mals)
Rokowania, prognozy i postęp choroby

Zespół więzadła łukowatego środkowego (MALS) to rzadkie schorzenie objawiające się przewlekłymi dolegliwościami brzusznymi spowodowanymi uciskiem tętnicy trzewnej. Leczenie chirurgiczne, obejmujące techniki otwarte, laparoskopowe i robotyczne, wykazuje zróżnicowane, ale generalnie obiecujące wyniki – od 75% do 100% pacjentów zgłasza poprawę objawów. W badaniach odsetek ustąpienia dolegliwości po 6-12 miesiącach wynosił od 20% do 90,3%, zależnie od metody operacyjnej. Zarówno laparoskopowe, jak i robotyczne uwolnienie więzadła są procedurami bezpiecznymi, z niskim ryzykiem powikłań i dobrymi wynikami długoterminowymi. Wskaźnik powodzenia operacji wynosi około 80% (całkowita lub częściowa ulga). Kluczowa jest selekcja pacjentów, z uwzględnieniem czynników prognostycznych takich jak ból powysiłkowy (P=0,022), wymioty (P=0,046), ból nieprowokowany (P=0,006) oraz współistniejący zespół aktywacji komórek tucznych (p=0,04), które wpływają na rokowanie po zabiegu.

  1. Prognoza zespołu więzadła łukowatego środkowego (MALS)
    1. Wyniki leczenia chirurgicznego
    2. Czynniki prognostyczne wpływające na wyniki leczenia
    3. Rokowanie w specyficznych grupach pacjentów
    4. Nawroty i monitorowanie długoterminowe
    5. Znaczenie zespołu multidyscyplinarnego
  2. Podsumowanie prognozy MALS
    1. Kolejne rozdziały

Prognoza zespołu więzadła łukowatego środkowego (MALS)

Zespół więzadła łukowatego środkowego (MALS) to rzadkie schorzenie charakteryzujące się przewlekłymi objawami brzusznymi związanymi z uciskiem tętnicy trzewnej przez więzadło łukowate środkowe. Przewidywanie wyników leczenia pozostaje wyzwaniem klinicznym z uwagi na złożoność schorzenia i ograniczoną liczbę badań o dużej skali.12

Wyniki leczenia chirurgicznego

Dostępne dane wskazują na zróżnicowane, ale generalnie obiecujące wyniki leczenia chirurgicznego MALS. W przeglądzie literatury obejmującym 35 badań z udziałem 691 pacjentów, od 75% do 100% chorych zgłaszało wyraźne zmniejszenie objawów po zabiegu chirurgicznym. W innym przeglądzie 85% pacjentów z MALS poddanych interwencji chirurgicznej doświadczyło natychmiastowej ulgi w objawach po operacji.3

Bardziej szczegółowe dane z poszczególnych badań pokazują następujące rezultaty:

  • W badaniu DeCarlo i wsp. porównującym różne techniki operacyjne, odsetek pacjentów zgłaszających ustąpienie objawów po 3 latach wynosił: 49,3% dla operacji metodą otwartą, 62,4% dla laparoskopowej i 37,7% dla robotycznej4
  • Shin i wsp. wykazali, że 76,9% pacjentów poddanych laparoskopii zgłaszało ustąpienie objawów po 6 miesiącach, w porównaniu do 50% pacjentów po operacji robotycznej5
  • Gerull i wsp. odnotowali 90,3% wskaźnik ustąpienia objawów po roku od operacji robotycznej u 74 pacjentów67
  • Chen i wsp. porównując trzy techniki operacyjne po roku od zabiegu odnotowali ustąpienie objawów u: 62% pacjentów po operacji otwartej, 20% po laparoskopii oraz 43% po operacji robotycznej8

Nowsze badania potwierdzają, że zarówno laparoskopowe, jak i robotyczne uwolnienie więzadła łukowatego środkowego są bezpiecznymi procedurami z niskim ryzykiem powikłań pooperacyjnych i dobrymi wynikami długoterminowymi. W jednym z badań odnotowano natychmiastową ulgę w objawach u 17 z 20 pacjentów po operacji, choć u czterech pacjentów objawy powróciły w późniejszym okresie, co daje ogólny wskaźnik powodzenia na poziomie 80% (całkowita lub częściowa ulga).910

Czynniki prognostyczne wpływające na wyniki leczenia

Identyfikacja czynników prognostycznych jest kluczowa dla właściwej selekcji pacjentów do leczenia chirurgicznego MALS. Dotychczasowe badania wskazują na kilka istotnych czynników:

Czynniki pozytywnie wpływające na rokowanie
  • Ból powysiłkowy – pacjenci zgłaszający ból występujący po wysiłku fizycznym mają większe prawdopodobieństwo poprawy po operacji (P = 0,022)11
Czynniki negatywnie wpływające na rokowanie
  • Wymioty jako objaw wiodący (P = 0,046)12
  • Ból nieprowokowany (niewyzwalany przez jedzenie czy wysiłek) (P = 0,006)13
  • Podeszły wiek14
  • Nadużywanie alkoholu w wywiadzie15
  • Choroby psychiczne16
  • Współistniejący zespół aktywacji komórek tucznych – koreluje istotnie statystycznie (p=0,04) z utrzymującymi się objawami po operacji17

Co interesujące, w przeciwieństwie do wcześniejszych badań, ból poposiłkowy nie został uznany za czynnik prognostyczny wyniku leczenia.18

Warto podkreślić, że dane demograficzne, radiologiczne czy parametry operacyjne nie wykazują wartości predykcyjnej w przewidywaniu ustąpienia objawów po operacji.1920

Rokowanie w specyficznych grupach pacjentów

MALS ma szczególne znaczenie w chirurgii wątrobowo-trzustkowo-żółciowej (HPB). Szacowana częstość występowania MALS w tej grupie pacjentów wynosi około 10%, zwłaszcza przy pancreatoduodenektomii i przeszczepianiu wątroby (OLT).21

Wyniki badań dotyczących wpływu MALS na rokowanie po zabiegach HPB nie są jednoznaczne:

  • Gialamas i wsp. nie wykazali statystycznie istotnych różnic w przeżywalności przeszczepu ani powikłaniach dróg żółciowych między pacjentami z MALS i bez tego schorzenia22
  • Inne europejskie badanie również nie wykazało różnic w wynikach krótko- i długoterminowych między pacjentami po przeszczepieniu wątroby z leczonym chirurgicznie MALS lub bez MALS23
  • Nowsze badanie sugeruje jednak, że nieleczony MALS wiąże się ze zwiększonym ryzykiem powikłań dróg żółciowych i zmniejszoną przeżywalnością przeszczepu, co podkreśla potencjalne znaczenie leczenia MALS przed przeszczepieniem wątroby24

Implikacje MALS są rzadziej zgłaszane w innych procedurach HPB, takich jak pankreatektomia dystalna i zespolenie wątrobowo-jelitowe sposobem Roux-en-Y, ponieważ są one wykonywane z minimalnym zaburzeniem krążenia obocznego.25

Nawroty i monitorowanie długoterminowe

Badania pokazują, że MALS może nawrócić po operacji. Chociaż nie można tego całkowicie zapobiec, świadomość potencjalnych wczesnych objawów nawrotu może pomóc w szybkiej interwencji.26

Długoterminowa obserwacja pacjentów z MALS jest niezbędna, ponieważ nawet po początkowym ustąpieniu objawów, mogą one powrócić u części pacjentów. W jednym z badań u 4 z 20 pacjentów zaobserwowano całkowity nawrót objawów podczas długoterminowej obserwacji, mimo początkowej poprawy.27

Znaczenie zespołu multidyscyplinarnego

Selekcja pacjentów, którzy najprawdopodobniej zareagują na chirurgiczne uwolnienie więzadła łukowatego środkowego, może być najlepiej realizowana poprzez połączenie wyników klinicznych i obrazowych w ramach interdyscyplinarnego zespołu gastroenterologów, radiologów i chirurgów.28

Ponadto, leczenie chirurgiczne powinno być starannie oceniane u pacjentów ze współistniejącym zespołem aktywacji komórek tucznych, co wymaga szczególnej uwagi zespołu wielospecjalistycznego.29

Podsumowanie prognozy MALS

Pomimo że MALS jest rzadkim schorzeniem, które często trudno rozpoznać, odpowiednie leczenie chirurgiczne może przynieść znaczącą poprawę u większości pacjentów. Wskaźniki powodzenia operacyjnego uwolnienia więzadła łukowatego środkowego wahają się między 75% a 100% w różnych badaniach, z dobrymi wynikami długoterminowymi.303132

Najlepsze wyniki leczenia można osiągnąć poprzez staranny dobór pacjentów w oparciu o zidentyfikowane czynniki prognostyczne oraz kompleksową ocenę przedoperacyjną. Szczególną uwagę należy zwrócić na pacjentów z czynnikami ryzyka gorszego wyniku, takimi jak ból nieprowokowany, wymioty jako główny objaw czy współistniejący zespół aktywacji komórek tucznych.3334

Wczesna diagnoza i rozpoczęcie leczenia MALS mogą prowadzić do lepszych wyników. Zespoły multidyscyplinarne odgrywają kluczową rolę w optymalizacji wyników leczenia tego złożonego schorzenia.3536

Kolejne rozdziały

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Wybierz kolejny rozdział z menu poniżej, aby otworzyć nową podstronę kompedium wiedzy i uzyskać szczegółowe informację o leku, substancji lub chorobie.

  1. 09.04.2026
  2. www.leksykon.com.pl

Materiały źródłowe

  • #1 Overview of Median Arcuate Ligament Syndrome: A Narrative Review
    https://pmc.ncbi.nlm.nih.gov/articles/PMC10629207/
    Median arcuate ligament syndrome is a rare disorder that is often difficult to recognize in patients who present with this condition. […] We hope that this review will aid physicians in making the diagnosis of this rare condition so that patients afflicted by MALS can begin treatment sooner to achieve better outcomes.
  • #2
    https://link.springer.com/article/10.1007/s00423-024-03511-9
    Median arcuate ligament syndrome (MALS) is a rare disorder caused by compression of the celiac artery (CA) by the median arcuate ligament (MAL). […] Despite being complex and challenging procedures, laparoscopic and robotic-assisted MAL release are safe procedures with low risk of postoperative complications and good longterm outcomes. […] The results of our study demonstrate that minimally invasive release of the MAL is a safe procedure with a low risk of peri- and postoperative complications and a good longterm outcome. […] Immediate symptom relief was noted in 17 out of 20 patients following surgery. However, at the last follow-up, four patients experienced complete symptom recurrence. As a result, the current study demonstrates an overall success rate of 80%, comprising complete or partial relief, for MAL release.
  • #3 Overview of Median Arcuate Ligament Syndrome: A Narrative Review
    https://pmc.ncbi.nlm.nih.gov/articles/PMC10629207/
    Median arcuate ligament syndrome (MALS) is a rare disorder caused primarily by compression of the celiac trunk by the median arcuate ligament (MAL). […] Most patients respond well to this treatment, though certain factors that predict a poorer response to treatment include elderly age, a history of alcohol abuse, and psychiatric illness. […] Data regarding the outcomes of patients who received treatment for MALS is lacking and has yielded somewhat conflicting results. […] One review found that in 35 studies involving a total of 691 patients, 75% to 100% of patients reported a clear reduction in symptoms after undergoing surgery. […] In another review of studies, 85% of MALS patients who underwent surgical intervention reported immediate symptom relief after surgery. […] A study by DeCarlo et al. compared outcomes between patients who underwent either open, laparoscopic, or robotic surgery for MALS.
  • #4 Overview of Median Arcuate Ligament Syndrome: A Narrative Review
    https://pmc.ncbi.nlm.nih.gov/articles/PMC10629207/
    Median arcuate ligament syndrome (MALS) is a rare disorder caused primarily by compression of the celiac trunk by the median arcuate ligament (MAL). […] Most patients respond well to this treatment, though certain factors that predict a poorer response to treatment include elderly age, a history of alcohol abuse, and psychiatric illness. […] Data regarding the outcomes of patients who received treatment for MALS is lacking and has yielded somewhat conflicting results. […] One review found that in 35 studies involving a total of 691 patients, 75% to 100% of patients reported a clear reduction in symptoms after undergoing surgery. […] In another review of studies, 85% of MALS patients who underwent surgical intervention reported immediate symptom relief after surgery. […] A study by DeCarlo et al. compared outcomes between patients who underwent either open, laparoscopic, or robotic surgery for MALS.
  • #5 Overview of Median Arcuate Ligament Syndrome: A Narrative Review
    https://pmc.ncbi.nlm.nih.gov/articles/PMC10629207/
    Their study showed that 49.3%, 62.4%, and 37.7% of patients had symptom relief at a three-year follow-up after undergoing open, laparoscopic, and robotic approaches to MALS surgery, respectively. […] In a study by Shin et al. that compared laparoscopic and robotic surgery for MALS, 50 patients underwent either of the two approaches to surgery. […] Of the 24 patients receiving laparoscopic surgery, 76.9% reported symptom relief at a six-month follow-up, […] However, of the 26 patients who received robotic surgery, only 50% reported symptom relief at a six-month follow-up. […] In another study by Gerull et al. testing the effectiveness of robotic surgery for MALS, 74 patients received this procedure, with 90.3% reporting symptom relief at a one-year follow-up. […] In a separate study by Chen et al. comparing open, laparoscopic, and robotic surgery for MALS, the cohort of 16 patients who underwent open surgery reported 62% symptom relief, while the laparoscopic cohort of 12 patients reported 20% symptom relief, and the robotic cohort of 17 patients reported 43% symptom relief, with all follow-ups being conducted one year after surgery.
  • #6 Overview of Median Arcuate Ligament Syndrome: A Narrative Review
    https://pmc.ncbi.nlm.nih.gov/articles/PMC10629207/
    Their study showed that 49.3%, 62.4%, and 37.7% of patients had symptom relief at a three-year follow-up after undergoing open, laparoscopic, and robotic approaches to MALS surgery, respectively. […] In a study by Shin et al. that compared laparoscopic and robotic surgery for MALS, 50 patients underwent either of the two approaches to surgery. […] Of the 24 patients receiving laparoscopic surgery, 76.9% reported symptom relief at a six-month follow-up, […] However, of the 26 patients who received robotic surgery, only 50% reported symptom relief at a six-month follow-up. […] In another study by Gerull et al. testing the effectiveness of robotic surgery for MALS, 74 patients received this procedure, with 90.3% reporting symptom relief at a one-year follow-up. […] In a separate study by Chen et al. comparing open, laparoscopic, and robotic surgery for MALS, the cohort of 16 patients who underwent open surgery reported 62% symptom relief, while the laparoscopic cohort of 12 patients reported 20% symptom relief, and the robotic cohort of 17 patients reported 43% symptom relief, with all follow-ups being conducted one year after surgery.
  • #7
    https://link.springer.com/article/10.1007/s00423-024-03511-9
    Clear predictive factors for symptom relief from surgery are still lacking, although they are of utmost importance for patient selection. […] In the largest series to date, encompassing 74 patients who underwent robotic MAL release, Gerull et al. report promising results with 90% of patients experiencing symptom relief at the 1-year follow-up. […] Our reported findings provide valuable insight into a procedure that has been poorly described thus far. […] Both, laparoscopic and robotic-assisted release of the median arcuate ligament are safe surgical procedures with low risk of postoperative complications and good peri- and postoperative outcomes for this complex and challenging surgery.
  • #8 Overview of Median Arcuate Ligament Syndrome: A Narrative Review
    https://pmc.ncbi.nlm.nih.gov/articles/PMC10629207/
    Their study showed that 49.3%, 62.4%, and 37.7% of patients had symptom relief at a three-year follow-up after undergoing open, laparoscopic, and robotic approaches to MALS surgery, respectively. […] In a study by Shin et al. that compared laparoscopic and robotic surgery for MALS, 50 patients underwent either of the two approaches to surgery. […] Of the 24 patients receiving laparoscopic surgery, 76.9% reported symptom relief at a six-month follow-up, […] However, of the 26 patients who received robotic surgery, only 50% reported symptom relief at a six-month follow-up. […] In another study by Gerull et al. testing the effectiveness of robotic surgery for MALS, 74 patients received this procedure, with 90.3% reporting symptom relief at a one-year follow-up. […] In a separate study by Chen et al. comparing open, laparoscopic, and robotic surgery for MALS, the cohort of 16 patients who underwent open surgery reported 62% symptom relief, while the laparoscopic cohort of 12 patients reported 20% symptom relief, and the robotic cohort of 17 patients reported 43% symptom relief, with all follow-ups being conducted one year after surgery.
  • #9
    https://link.springer.com/article/10.1007/s00423-024-03511-9
    Median arcuate ligament syndrome (MALS) is a rare disorder caused by compression of the celiac artery (CA) by the median arcuate ligament (MAL). […] Despite being complex and challenging procedures, laparoscopic and robotic-assisted MAL release are safe procedures with low risk of postoperative complications and good longterm outcomes. […] The results of our study demonstrate that minimally invasive release of the MAL is a safe procedure with a low risk of peri- and postoperative complications and a good longterm outcome. […] Immediate symptom relief was noted in 17 out of 20 patients following surgery. However, at the last follow-up, four patients experienced complete symptom recurrence. As a result, the current study demonstrates an overall success rate of 80%, comprising complete or partial relief, for MAL release.
  • #10
    https://link.springer.com/article/10.1007/s00423-024-03511-9
    Clear predictive factors for symptom relief from surgery are still lacking, although they are of utmost importance for patient selection. […] In the largest series to date, encompassing 74 patients who underwent robotic MAL release, Gerull et al. report promising results with 90% of patients experiencing symptom relief at the 1-year follow-up. […] Our reported findings provide valuable insight into a procedure that has been poorly described thus far. […] Both, laparoscopic and robotic-assisted release of the median arcuate ligament are safe surgical procedures with low risk of postoperative complications and good peri- and postoperative outcomes for this complex and challenging surgery.
  • #11 Outcome predictors in median arcuate ligament syndrome – PubMed
    https://pubmed.ncbi.nlm.nih.gov/28189355/
    Median arcuate ligament syndrome (MALS) is a condition characterized by chronic abdominal symptoms associated with median arcuate ligament compression of the celiac artery. The selection of patients is difficult in the management of MALS. This study aimed to identify factors that predict outcomes of surgical and nonoperative treatment in these patients. […] After surgical treatment, 16 (37%) were asymptomatic, 24 (56%) were partially improved, 3 (7%) had no changes in symptoms, and none had worsening of symptoms. Postexertional pain predicted improvement after surgery (P = .022). Vomiting (P = .046) and unprovoked pain (P = .006) were predictors of poor surgical outcome. […] MALS was more likely to respond to decompression if patients had postexertional pain. Patients who presented with vomiting and unprovoked pain were unlikely to respond to surgery. In contrast with previous studies, postprandial pain was not found to be predictive of outcome.
  • #12 Outcome predictors in median arcuate ligament syndrome – PubMed
    https://pubmed.ncbi.nlm.nih.gov/28189355/
    Median arcuate ligament syndrome (MALS) is a condition characterized by chronic abdominal symptoms associated with median arcuate ligament compression of the celiac artery. The selection of patients is difficult in the management of MALS. This study aimed to identify factors that predict outcomes of surgical and nonoperative treatment in these patients. […] After surgical treatment, 16 (37%) were asymptomatic, 24 (56%) were partially improved, 3 (7%) had no changes in symptoms, and none had worsening of symptoms. Postexertional pain predicted improvement after surgery (P = .022). Vomiting (P = .046) and unprovoked pain (P = .006) were predictors of poor surgical outcome. […] MALS was more likely to respond to decompression if patients had postexertional pain. Patients who presented with vomiting and unprovoked pain were unlikely to respond to surgery. In contrast with previous studies, postprandial pain was not found to be predictive of outcome.
  • #13 Outcome predictors in median arcuate ligament syndrome – PubMed
    https://pubmed.ncbi.nlm.nih.gov/28189355/
    Median arcuate ligament syndrome (MALS) is a condition characterized by chronic abdominal symptoms associated with median arcuate ligament compression of the celiac artery. The selection of patients is difficult in the management of MALS. This study aimed to identify factors that predict outcomes of surgical and nonoperative treatment in these patients. […] After surgical treatment, 16 (37%) were asymptomatic, 24 (56%) were partially improved, 3 (7%) had no changes in symptoms, and none had worsening of symptoms. Postexertional pain predicted improvement after surgery (P = .022). Vomiting (P = .046) and unprovoked pain (P = .006) were predictors of poor surgical outcome. […] MALS was more likely to respond to decompression if patients had postexertional pain. Patients who presented with vomiting and unprovoked pain were unlikely to respond to surgery. In contrast with previous studies, postprandial pain was not found to be predictive of outcome.
  • #14 Overview of Median Arcuate Ligament Syndrome: A Narrative Review
    https://pmc.ncbi.nlm.nih.gov/articles/PMC10629207/
    Median arcuate ligament syndrome (MALS) is a rare disorder caused primarily by compression of the celiac trunk by the median arcuate ligament (MAL). […] Most patients respond well to this treatment, though certain factors that predict a poorer response to treatment include elderly age, a history of alcohol abuse, and psychiatric illness. […] Data regarding the outcomes of patients who received treatment for MALS is lacking and has yielded somewhat conflicting results. […] One review found that in 35 studies involving a total of 691 patients, 75% to 100% of patients reported a clear reduction in symptoms after undergoing surgery. […] In another review of studies, 85% of MALS patients who underwent surgical intervention reported immediate symptom relief after surgery. […] A study by DeCarlo et al. compared outcomes between patients who underwent either open, laparoscopic, or robotic surgery for MALS.
  • #15 Overview of Median Arcuate Ligament Syndrome: A Narrative Review
    https://pmc.ncbi.nlm.nih.gov/articles/PMC10629207/
    Median arcuate ligament syndrome (MALS) is a rare disorder caused primarily by compression of the celiac trunk by the median arcuate ligament (MAL). […] Most patients respond well to this treatment, though certain factors that predict a poorer response to treatment include elderly age, a history of alcohol abuse, and psychiatric illness. […] Data regarding the outcomes of patients who received treatment for MALS is lacking and has yielded somewhat conflicting results. […] One review found that in 35 studies involving a total of 691 patients, 75% to 100% of patients reported a clear reduction in symptoms after undergoing surgery. […] In another review of studies, 85% of MALS patients who underwent surgical intervention reported immediate symptom relief after surgery. […] A study by DeCarlo et al. compared outcomes between patients who underwent either open, laparoscopic, or robotic surgery for MALS.
  • #16 Overview of Median Arcuate Ligament Syndrome: A Narrative Review
    https://pmc.ncbi.nlm.nih.gov/articles/PMC10629207/
    Median arcuate ligament syndrome (MALS) is a rare disorder caused primarily by compression of the celiac trunk by the median arcuate ligament (MAL). […] Most patients respond well to this treatment, though certain factors that predict a poorer response to treatment include elderly age, a history of alcohol abuse, and psychiatric illness. […] Data regarding the outcomes of patients who received treatment for MALS is lacking and has yielded somewhat conflicting results. […] One review found that in 35 studies involving a total of 691 patients, 75% to 100% of patients reported a clear reduction in symptoms after undergoing surgery. […] In another review of studies, 85% of MALS patients who underwent surgical intervention reported immediate symptom relief after surgery. […] A study by DeCarlo et al. compared outcomes between patients who underwent either open, laparoscopic, or robotic surgery for MALS.
  • #17 Prognostic factors for the long term outcome after surgical celiac artery decompression in MALS | Orphanet Journal of Rare Diseases | Full Text
    https://ojrd.biomedcentral.com/articles/10.1186/s13023-023-02952-7
    Overall, laparoscopic MAL release can provide immediate symptomatic relief. […] Despite the missing predictive value of demographic and imaging data, our data show a correlation between persistent symptoms and a co-existing mast cell activation syndrome. […] No demographic, radiologic or operative parameter was able to predict postoperative symptom relief. […] However, mast cell activation syndrome correlated significantly (p=0.04) with persistent symptoms after the operation. […] 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. […] Furthermore, surgical treatment should be evaluated carefully in patients with co-existing mast cell activation syndrome.
  • #18 Outcome predictors in median arcuate ligament syndrome – PubMed
    https://pubmed.ncbi.nlm.nih.gov/28189355/
    Median arcuate ligament syndrome (MALS) is a condition characterized by chronic abdominal symptoms associated with median arcuate ligament compression of the celiac artery. The selection of patients is difficult in the management of MALS. This study aimed to identify factors that predict outcomes of surgical and nonoperative treatment in these patients. […] After surgical treatment, 16 (37%) were asymptomatic, 24 (56%) were partially improved, 3 (7%) had no changes in symptoms, and none had worsening of symptoms. Postexertional pain predicted improvement after surgery (P = .022). Vomiting (P = .046) and unprovoked pain (P = .006) were predictors of poor surgical outcome. […] MALS was more likely to respond to decompression if patients had postexertional pain. Patients who presented with vomiting and unprovoked pain were unlikely to respond to surgery. In contrast with previous studies, postprandial pain was not found to be predictive of outcome.
  • #19 Prognostic factors for the long term outcome after surgical celiac artery decompression in MALS | Orphanet Journal of Rare Diseases | Full Text
    https://ojrd.biomedcentral.com/articles/10.1186/s13023-023-02952-7
    Overall, laparoscopic MAL release can provide immediate symptomatic relief. […] Despite the missing predictive value of demographic and imaging data, our data show a correlation between persistent symptoms and a co-existing mast cell activation syndrome. […] No demographic, radiologic or operative parameter was able to predict postoperative symptom relief. […] However, mast cell activation syndrome correlated significantly (p=0.04) with persistent symptoms after the operation. […] 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. […] Furthermore, surgical treatment should be evaluated carefully in patients with co-existing mast cell activation syndrome.
  • #20
    https://link.springer.com/article/10.1007/s00423-024-03511-9
    Clear predictive factors for symptom relief from surgery are still lacking, although they are of utmost importance for patient selection. […] In the largest series to date, encompassing 74 patients who underwent robotic MAL release, Gerull et al. report promising results with 90% of patients experiencing symptom relief at the 1-year follow-up. […] Our reported findings provide valuable insight into a procedure that has been poorly described thus far. […] Both, laparoscopic and robotic-assisted release of the median arcuate ligament are safe surgical procedures with low risk of postoperative complications and good peri- and postoperative outcomes for this complex and challenging surgery.
  • #21 Median Arcuate Ligament Syndrome (MALS) in Hepato-Pancreato-Biliary Surgery: A Narrative Review and Proposed Management Algorithm
    https://www.mdpi.com/2077-0383/13/9/2598
    Median arcuate ligament syndrome (MALS) is an uncommon condition characterized by the compression of the celiac trunk by the median arcuate ligament. […] The estimated prevalence of MALS in HPB surgery is approximately 10%. […] The reported prevalence of MALS in PD and OLT is approximately 10%. […] Gialamas et al. demonstrated no statistically significant difference in graft survival or post-operative biliary complications between patients with and without MALS in their retrospective case–control study. […] Another single-center European study also showed no differences in short- and long-term outcomes between OLT patients with surgically treated MALS or without MALS. […] On the contrary, a recent study reported that untreated MALS is associated with increased biliary complications and reduced graft survival highlighting the potential importance of MALS management prior to OLT.
  • #22 Median Arcuate Ligament Syndrome (MALS) in Hepato-Pancreato-Biliary Surgery: A Narrative Review and Proposed Management Algorithm
    https://www.mdpi.com/2077-0383/13/9/2598
    Median arcuate ligament syndrome (MALS) is an uncommon condition characterized by the compression of the celiac trunk by the median arcuate ligament. […] The estimated prevalence of MALS in HPB surgery is approximately 10%. […] The reported prevalence of MALS in PD and OLT is approximately 10%. […] Gialamas et al. demonstrated no statistically significant difference in graft survival or post-operative biliary complications between patients with and without MALS in their retrospective case–control study. […] Another single-center European study also showed no differences in short- and long-term outcomes between OLT patients with surgically treated MALS or without MALS. […] On the contrary, a recent study reported that untreated MALS is associated with increased biliary complications and reduced graft survival highlighting the potential importance of MALS management prior to OLT.
  • #23 Median Arcuate Ligament Syndrome (MALS) in Hepato-Pancreato-Biliary Surgery: A Narrative Review and Proposed Management Algorithm
    https://www.mdpi.com/2077-0383/13/9/2598
    Median arcuate ligament syndrome (MALS) is an uncommon condition characterized by the compression of the celiac trunk by the median arcuate ligament. […] The estimated prevalence of MALS in HPB surgery is approximately 10%. […] The reported prevalence of MALS in PD and OLT is approximately 10%. […] Gialamas et al. demonstrated no statistically significant difference in graft survival or post-operative biliary complications between patients with and without MALS in their retrospective case–control study. […] Another single-center European study also showed no differences in short- and long-term outcomes between OLT patients with surgically treated MALS or without MALS. […] On the contrary, a recent study reported that untreated MALS is associated with increased biliary complications and reduced graft survival highlighting the potential importance of MALS management prior to OLT.
  • #24 Median Arcuate Ligament Syndrome (MALS) in Hepato-Pancreato-Biliary Surgery: A Narrative Review and Proposed Management Algorithm
    https://www.mdpi.com/2077-0383/13/9/2598
    Median arcuate ligament syndrome (MALS) is an uncommon condition characterized by the compression of the celiac trunk by the median arcuate ligament. […] The estimated prevalence of MALS in HPB surgery is approximately 10%. […] The reported prevalence of MALS in PD and OLT is approximately 10%. […] Gialamas et al. demonstrated no statistically significant difference in graft survival or post-operative biliary complications between patients with and without MALS in their retrospective case–control study. […] Another single-center European study also showed no differences in short- and long-term outcomes between OLT patients with surgically treated MALS or without MALS. […] On the contrary, a recent study reported that untreated MALS is associated with increased biliary complications and reduced graft survival highlighting the potential importance of MALS management prior to OLT.
  • #25 Median Arcuate Ligament Syndrome (MALS) in Hepato-Pancreato-Biliary Surgery: A Narrative Review and Proposed Management Algorithm
    https://www.mdpi.com/2077-0383/13/9/2598
    The implications of MALS are less frequently reported in other HPB procedures, such as distal pancreatectomy and Roux-en-Y hepaticojejunostomy, as they are open or performed laparoscopically with minimal disruption to the collateral blood supply. […] In conclusion, HPB patients with MALS require thorough preoperative assessment and surgical planning.
  • #26 MALS (Median Arcuate Ligament Syndrome): Symptoms & Diagnosis
    https://my.clevelandclinic.org/health/diseases/16635-median-arcuate-ligament-syndrome-mals
    Surgery often eases symptoms. But research shows median arcuate ligament syndrome can come back after surgery. […] You cant keep that from happening. But knowing what changes in your body may mean MALS is back may help. […] Ask your healthcare provider about early changes. Theyll be glad to explain what may be signs of trouble.
  • #27
    https://link.springer.com/article/10.1007/s00423-024-03511-9
    Median arcuate ligament syndrome (MALS) is a rare disorder caused by compression of the celiac artery (CA) by the median arcuate ligament (MAL). […] Despite being complex and challenging procedures, laparoscopic and robotic-assisted MAL release are safe procedures with low risk of postoperative complications and good longterm outcomes. […] The results of our study demonstrate that minimally invasive release of the MAL is a safe procedure with a low risk of peri- and postoperative complications and a good longterm outcome. […] Immediate symptom relief was noted in 17 out of 20 patients following surgery. However, at the last follow-up, four patients experienced complete symptom recurrence. As a result, the current study demonstrates an overall success rate of 80%, comprising complete or partial relief, for MAL release.
  • #28 Prognostic factors for the long term outcome after surgical celiac artery decompression in MALS | Orphanet Journal of Rare Diseases | Full Text
    https://ojrd.biomedcentral.com/articles/10.1186/s13023-023-02952-7
    Overall, laparoscopic MAL release can provide immediate symptomatic relief. […] Despite the missing predictive value of demographic and imaging data, our data show a correlation between persistent symptoms and a co-existing mast cell activation syndrome. […] No demographic, radiologic or operative parameter was able to predict postoperative symptom relief. […] However, mast cell activation syndrome correlated significantly (p=0.04) with persistent symptoms after the operation. […] 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. […] Furthermore, surgical treatment should be evaluated carefully in patients with co-existing mast cell activation syndrome.
  • #29 Prognostic factors for the long term outcome after surgical celiac artery decompression in MALS | Orphanet Journal of Rare Diseases | Full Text
    https://ojrd.biomedcentral.com/articles/10.1186/s13023-023-02952-7
    Overall, laparoscopic MAL release can provide immediate symptomatic relief. […] Despite the missing predictive value of demographic and imaging data, our data show a correlation between persistent symptoms and a co-existing mast cell activation syndrome. […] No demographic, radiologic or operative parameter was able to predict postoperative symptom relief. […] However, mast cell activation syndrome correlated significantly (p=0.04) with persistent symptoms after the operation. […] 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. […] Furthermore, surgical treatment should be evaluated carefully in patients with co-existing mast cell activation syndrome.
  • #30 Overview of Median Arcuate Ligament Syndrome: A Narrative Review
    https://pmc.ncbi.nlm.nih.gov/articles/PMC10629207/
    Median arcuate ligament syndrome (MALS) is a rare disorder caused primarily by compression of the celiac trunk by the median arcuate ligament (MAL). […] Most patients respond well to this treatment, though certain factors that predict a poorer response to treatment include elderly age, a history of alcohol abuse, and psychiatric illness. […] Data regarding the outcomes of patients who received treatment for MALS is lacking and has yielded somewhat conflicting results. […] One review found that in 35 studies involving a total of 691 patients, 75% to 100% of patients reported a clear reduction in symptoms after undergoing surgery. […] In another review of studies, 85% of MALS patients who underwent surgical intervention reported immediate symptom relief after surgery. […] A study by DeCarlo et al. compared outcomes between patients who underwent either open, laparoscopic, or robotic surgery for MALS.
  • #31 Overview of Median Arcuate Ligament Syndrome: A Narrative Review
    https://pmc.ncbi.nlm.nih.gov/articles/PMC10629207/
    Their study showed that 49.3%, 62.4%, and 37.7% of patients had symptom relief at a three-year follow-up after undergoing open, laparoscopic, and robotic approaches to MALS surgery, respectively. […] In a study by Shin et al. that compared laparoscopic and robotic surgery for MALS, 50 patients underwent either of the two approaches to surgery. […] Of the 24 patients receiving laparoscopic surgery, 76.9% reported symptom relief at a six-month follow-up, […] However, of the 26 patients who received robotic surgery, only 50% reported symptom relief at a six-month follow-up. […] In another study by Gerull et al. testing the effectiveness of robotic surgery for MALS, 74 patients received this procedure, with 90.3% reporting symptom relief at a one-year follow-up. […] In a separate study by Chen et al. comparing open, laparoscopic, and robotic surgery for MALS, the cohort of 16 patients who underwent open surgery reported 62% symptom relief, while the laparoscopic cohort of 12 patients reported 20% symptom relief, and the robotic cohort of 17 patients reported 43% symptom relief, with all follow-ups being conducted one year after surgery.
  • #32
    https://link.springer.com/article/10.1007/s00423-024-03511-9
    Median arcuate ligament syndrome (MALS) is a rare disorder caused by compression of the celiac artery (CA) by the median arcuate ligament (MAL). […] Despite being complex and challenging procedures, laparoscopic and robotic-assisted MAL release are safe procedures with low risk of postoperative complications and good longterm outcomes. […] The results of our study demonstrate that minimally invasive release of the MAL is a safe procedure with a low risk of peri- and postoperative complications and a good longterm outcome. […] Immediate symptom relief was noted in 17 out of 20 patients following surgery. However, at the last follow-up, four patients experienced complete symptom recurrence. As a result, the current study demonstrates an overall success rate of 80%, comprising complete or partial relief, for MAL release.
  • #33 Outcome predictors in median arcuate ligament syndrome – PubMed
    https://pubmed.ncbi.nlm.nih.gov/28189355/
    Median arcuate ligament syndrome (MALS) is a condition characterized by chronic abdominal symptoms associated with median arcuate ligament compression of the celiac artery. The selection of patients is difficult in the management of MALS. This study aimed to identify factors that predict outcomes of surgical and nonoperative treatment in these patients. […] After surgical treatment, 16 (37%) were asymptomatic, 24 (56%) were partially improved, 3 (7%) had no changes in symptoms, and none had worsening of symptoms. Postexertional pain predicted improvement after surgery (P = .022). Vomiting (P = .046) and unprovoked pain (P = .006) were predictors of poor surgical outcome. […] MALS was more likely to respond to decompression if patients had postexertional pain. Patients who presented with vomiting and unprovoked pain were unlikely to respond to surgery. In contrast with previous studies, postprandial pain was not found to be predictive of outcome.
  • #34 Prognostic factors for the long term outcome after surgical celiac artery decompression in MALS | Orphanet Journal of Rare Diseases | Full Text
    https://ojrd.biomedcentral.com/articles/10.1186/s13023-023-02952-7
    Overall, laparoscopic MAL release can provide immediate symptomatic relief. […] Despite the missing predictive value of demographic and imaging data, our data show a correlation between persistent symptoms and a co-existing mast cell activation syndrome. […] No demographic, radiologic or operative parameter was able to predict postoperative symptom relief. […] However, mast cell activation syndrome correlated significantly (p=0.04) with persistent symptoms after the operation. […] 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. […] Furthermore, surgical treatment should be evaluated carefully in patients with co-existing mast cell activation syndrome.
  • #35 Overview of Median Arcuate Ligament Syndrome: A Narrative Review
    https://pmc.ncbi.nlm.nih.gov/articles/PMC10629207/
    Median arcuate ligament syndrome is a rare disorder that is often difficult to recognize in patients who present with this condition. […] We hope that this review will aid physicians in making the diagnosis of this rare condition so that patients afflicted by MALS can begin treatment sooner to achieve better outcomes.
  • #36 Prognostic factors for the long term outcome after surgical celiac artery decompression in MALS | Orphanet Journal of Rare Diseases | Full Text
    https://ojrd.biomedcentral.com/articles/10.1186/s13023-023-02952-7
    Overall, laparoscopic MAL release can provide immediate symptomatic relief. […] Despite the missing predictive value of demographic and imaging data, our data show a correlation between persistent symptoms and a co-existing mast cell activation syndrome. […] No demographic, radiologic or operative parameter was able to predict postoperative symptom relief. […] However, mast cell activation syndrome correlated significantly (p=0.04) with persistent symptoms after the operation. […] 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. […] Furthermore, surgical treatment should be evaluated carefully in patients with co-existing mast cell activation syndrome.

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pankreatektomia dystalna pancreatoduodenektomia nawrót choroby zespolenie wątrobowo-jelitowe radiolog laparoskopia chirurg więzadło łukowate środkowe zespół aktywacji komórek tucznych zespół więzadła łukowatego środkowego krążenie oboczne ból poposiłkowy gastroenterolog zabieg chirurgiczny przeszczep wątroby wymioty tętnica trzewna operacja robotyczna powikłania pooperacyjne