Most studies evaluating the outcomes of MALS are retrospective reviews of single-center experiences spanning many years and having a relatively small number of patients. For this reason, the level of scientific evidence is low and there is a great deal of discussion among experts with respect to best practices, the role of celiac ganglion block, and the superiority of open surgical or laparoscopic approach.
A recent landmark study presented by Gustavo Oderich, MD and colleagues summarized the long-term follow up of 100 consecutive patients treated for MALS. In that study open surgical release was used in 81 patients and laparoscopic release in 19 patients (1). There were no operative or procedure mortality. One patient treated by laparoscopic release sustained a celiac artery injury extending to the aorta, which required emergent conversion to open surgery. Symptom improvement was noted in 80% of patients, with five-year freedom from recurrence symptoms in 70%. Among patients who answered a questionnaire on average seven years after the operation, 87% reported that they would still undergo operative management if given the choice.