Robotic-assisted approach to Median Arcuate Ligament Syndrome with left gastric artery originating directly from the aorta. Report of a case and review of the current mini-invasive treatment modalities

Background: Median Arcuate Ligament Syndrome (MALS) is a rare clinical condition. Methods: Through the analysis of a case report and a review of the international literature, we examined whether robotic and laparoscopic MAL release are safe and feasible. Results: Of 354 and 19 patients who underwent laparoscopic MAL release (LMALr) and robotic-assisted MAL release (RMALr), respectively, conversion to open surgery occurred in 6.8% of cases following LMALr, whereas no case of conversion was reported following RMALr. Immediate symptomatic improvement was reported in 92.1% of cases following LMALr and in 84.2% of cases following RMALr. In the LMALr group 9% of patients presented with recurrence of symptoms, whereas the percentage in the RMALr group was 5.3%. LMALr was related to a higher overall complication rate when compared with RMALr (7.3% vs 5.3%). Conclusions: Both laparoscopic and robotic-assisted MAL lysis with celiac ganglionectomy can be safely performed with minimal patient morbidity.