Materiały źródłowe

• #1 Median arcuate ligament syndrome (MALS) – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/median-arcuate-ligament-syndrome-mals/diagnosis-treatment/drc-20505007

  Surgery is the only treatment for median arcuate ligament syndrome, also called MALS. Surgery for MALS can improve or reduce symptoms in most people. […] The most common surgical treatment is median arcuate ligament release, also called decompression. It’s usually done as an open surgery through a cut in the belly area. Sometimes it is done using a camera and small instruments passed through several smaller openings. This is called laparoscopic surgery. […] During decompression surgery, the surgeon cuts away parts of the median arcuate ligament. This reduces pressure on the celiac artery and nerves. The surgeon removes the nerves around the celiac artery and its branches. Bundles of nerves on each side of the celiac artery also may be removed. […] Some people with MALS also may need surgery to repair or replace a blocked celiac artery and restore blood flow.

• #2 Median arcuate ligament syndrome (MALS) | Altru Health System

  https://www.altru.org/health-library/conditions/median-arcuate-ligament-syndrome-mals

  Treatment involves surgery to release pressure from the ligament on the artery and nerves. […] Surgery is the only treatment for median arcuate ligament syndrome, also called MALS. Surgery for MALS can improve or reduce symptoms in most people. […] The most common surgical treatment is median arcuate ligament release, also called decompression. It’s usually done as an open surgery through a cut in the belly area. Sometimes it is done using a camera and small instruments passed through several smaller openings. This is called laparoscopic surgery. […] During decompression surgery, the surgeon cuts away parts of the median arcuate ligament. This reduces pressure on the celiac artery and nerves. The surgeon removes the nerves around the celiac artery and its branches. Bundles of nerves on each side of the celiac artery also may be removed.

• #3 UT Physicians | Median arcuate ligament syndrome (MALS)

  https://www.utphysicians.com/median-arcuate-ligament-syndrome/

  The standard treatment of MALS is the release of the celiac artery by open surgical or laparoscopic removal of portions of the median arcuate ligament and ganglionic tissue that surround or completely encase the celiac artery. Regardless of the specific approach, the operation requires meticulous release of the celiac artery by division of muscle fibers from the median arcuate ligament and surgical removal of the overlying lymphatic, ganglionic, and soft tissue. The term neurolysis is used to describe the removal of nerve and ganglionic tissue that surrounds the artery in the front, sides, and back. In some patients inflammation and scar tissue is also removed. There are three main types of surgeries to treat MALS, all of which have a role. Surgical treatments can be done using open, laparoscopic, or endovascular methods. Surgical treatment is aimed to reduce or eliminate pain and improve the quality of life for the patient.

• #4 UT Physicians | Median arcuate ligament syndrome (MALS)

  https://www.utphysicians.com/median-arcuate-ligament-syndrome/

  The standard treatment of MALS is the release of the celiac artery by open surgical or laparoscopic removal of portions of the median arcuate ligament and ganglionic tissue that surround or completely encase the celiac artery. Regardless of the specific approach, the operation requires meticulous release of the celiac artery by division of muscle fibers from the median arcuate ligament and surgical removal of the overlying lymphatic, ganglionic, and soft tissue. The term neurolysis is used to describe the removal of nerve and ganglionic tissue that surrounds the artery in the front, sides, and back. In some patients inflammation and scar tissue is also removed. There are three main types of surgeries to treat MALS, all of which have a role. Surgical treatments can be done using open, laparoscopic, or endovascular methods. Surgical treatment is aimed to reduce or eliminate pain and improve the quality of life for the patient.

• #5 UT Physicians | Median arcuate ligament syndrome (MALS)

  https://www.utphysicians.com/median-arcuate-ligament-syndrome/

  Open surgical release of the median arcuate ligament is most often done using an incision in the epigastric area. The incision typically extends two-thirds of the distance between the lower end of the breast bone toward the umbilical scar. The surgeon exposes the area between the stomach and liver to visualize the median arcuate ligament. Using a combination of sharp dissection with scissors and cautery, the celiac artery is circumferentially freed from the muscle and ganglionic tissue, which are partially removed. Once the artery is freed, our preference is to obtain an intraoperative duplex arterial ultrasound to document that the artery is not severely narrowed or occluded. In cases of severe narrowing, the artery may be immediately repaired by placement of a small prosthetic patch or graft. The main advantages of the open surgical approach rely on the safety of surgical dissection under direct vision and ability to handle any small tear or areas of bleeding. This approach also allows thorough and complete circumferential release of the artery, including the tissue that lies behind the celiac artery. In addition, any severe narrowing can be immediately repaired.

• #6 UT Physicians | Median arcuate ligament syndrome (MALS)

  https://www.utphysicians.com/median-arcuate-ligament-syndrome/

  Open surgical release of the median arcuate ligament is most often done using an incision in the epigastric area. The incision typically extends two-thirds of the distance between the lower end of the breast bone toward the umbilical scar. The surgeon exposes the area between the stomach and liver to visualize the median arcuate ligament. Using a combination of sharp dissection with scissors and cautery, the celiac artery is circumferentially freed from the muscle and ganglionic tissue, which are partially removed. Once the artery is freed, our preference is to obtain an intraoperative duplex arterial ultrasound to document that the artery is not severely narrowed or occluded. In cases of severe narrowing, the artery may be immediately repaired by placement of a small prosthetic patch or graft. The main advantages of the open surgical approach rely on the safety of surgical dissection under direct vision and ability to handle any small tear or areas of bleeding. This approach also allows thorough and complete circumferential release of the artery, including the tissue that lies behind the celiac artery. In addition, any severe narrowing can be immediately repaired.

• #7 UT Physicians | Median arcuate ligament syndrome (MALS)

  https://www.utphysicians.com/median-arcuate-ligament-syndrome/

  Open surgical release of the median arcuate ligament is most often done using an incision in the epigastric area. The incision typically extends two-thirds of the distance between the lower end of the breast bone toward the umbilical scar. The surgeon exposes the area between the stomach and liver to visualize the median arcuate ligament. Using a combination of sharp dissection with scissors and cautery, the celiac artery is circumferentially freed from the muscle and ganglionic tissue, which are partially removed. Once the artery is freed, our preference is to obtain an intraoperative duplex arterial ultrasound to document that the artery is not severely narrowed or occluded. In cases of severe narrowing, the artery may be immediately repaired by placement of a small prosthetic patch or graft. The main advantages of the open surgical approach rely on the safety of surgical dissection under direct vision and ability to handle any small tear or areas of bleeding. This approach also allows thorough and complete circumferential release of the artery, including the tissue that lies behind the celiac artery. In addition, any severe narrowing can be immediately repaired.

• #8 Median Arcuate Ligament Syndrome (MALS) | University Hospitals | University Hospitals

  https://www.uhhospitals.org/services/heart-and-vascular-services/conditions-and-treatments/vascular-disease/median-arcuate-ligament-syndrome

  Most people who get this procedure report that their MALS symptoms, such as pain with eating and chronic pain in the upper middle stomach area, significantly improve after their surgery. Patients generally are able to return to their normal activities within two weeks. […] Some people with MALS must get traditional surgery instead. In the open technique, a vascular surgeon makes a large incision down the middle of the abdomen. People who have the open MALS release procedure may need to stay in the hospital for three to five days to recover. These patients can usually return to their normal activities within four to six weeks. […] Most people who have surgery for MALS will have a duplex ultrasound a month after their procedure to check to see that there is no further compression of the median arcuate ligament.

• #9 UT Physicians | Median arcuate ligament syndrome (MALS)

  https://www.utphysicians.com/median-arcuate-ligament-syndrome/

  Laparoscopic release of the celiac artery requires small holes to introduce the camera and surgical instruments without the larger incision. The surgeon works with camera visualization using scissors and cautery. Although the same steps are performed, the operation has the advantage of smaller incisions and the potential disadvantage of risk of bleeding complications or a less thorough release of the ligament. It is critical that the laparoscopic approach is performed by a surgeon with extensive experience in laparoscopy and familiarity with surgical dissection of the celiac artery. Moreover, if laparoscopy is selected, the procedure needs to be performed in surgical environment and by a team that is ready to perform conversion and arterial repair, if needed. […] Endovascular approach is not recommended as a stand-alone therapy because the muscle and ligament cause persistent compression of the artery, which typically recoils back to its compressed state after the balloon angioplasty. In fact, patients who are treated by angioplasty balloon and stent placement without prior surgical release of the ligament may experience complete occlusion or fracture of the stent due to the median arcuate ligament compression. Most often, endovascular approach is used in conjunction with previous laparoscopic or open surgical release to treat residual narrowing of the artery following the surgical release. In these cases, the procedure can be done under a local anesthetic with a small puncture in the groin artery. A catheter is introduced into the celiac artery and the narrowing is dilated with balloon angioplasty. Typically, a stent is also placed.

• #10 Median Arcuate Ligament Syndrome (MALS) | University Hospitals | University Hospitals

  https://www.uhhospitals.org/services/heart-and-vascular-services/conditions-and-treatments/vascular-disease/median-arcuate-ligament-syndrome

  Presently, the only treatment option for MALS is surgery. The most common such procedure is called a median arcuate ligament release, or median arcuate ligament decompression, which is done to reduce painful compression of the median arcuate ligament on the celiac artery. This surgery is increasingly performed as a minimally invasive (laparoscopic or robotic) procedure but is also done as traditional open surgery. […] In the laparoscopic technique, a vascular surgeon makes five to six small (about 1/2-inch) incisions and inserts instruments through them to separate the median arcuate ligament and divide the nerves of the celiac plexus (neurolysis). The operation stops the ligament from putting pressure on the celiac artery, restores normal blood flow and relieves pressure on the surrounding nerves.

• #11 UT Physicians | Median arcuate ligament syndrome (MALS)

  https://www.utphysicians.com/median-arcuate-ligament-syndrome/

  Laparoscopic release of the celiac artery requires small holes to introduce the camera and surgical instruments without the larger incision. The surgeon works with camera visualization using scissors and cautery. Although the same steps are performed, the operation has the advantage of smaller incisions and the potential disadvantage of risk of bleeding complications or a less thorough release of the ligament. It is critical that the laparoscopic approach is performed by a surgeon with extensive experience in laparoscopy and familiarity with surgical dissection of the celiac artery. Moreover, if laparoscopy is selected, the procedure needs to be performed in surgical environment and by a team that is ready to perform conversion and arterial repair, if needed. […] Endovascular approach is not recommended as a stand-alone therapy because the muscle and ligament cause persistent compression of the artery, which typically recoils back to its compressed state after the balloon angioplasty. In fact, patients who are treated by angioplasty balloon and stent placement without prior surgical release of the ligament may experience complete occlusion or fracture of the stent due to the median arcuate ligament compression. Most often, endovascular approach is used in conjunction with previous laparoscopic or open surgical release to treat residual narrowing of the artery following the surgical release. In these cases, the procedure can be done under a local anesthetic with a small puncture in the groin artery. A catheter is introduced into the celiac artery and the narrowing is dilated with balloon angioplasty. Typically, a stent is also placed.

• #12 Laparoscopic treatment of rare median arcuate ligament…

  https://ppch.pl/seo/article/01.3001.0015.4214/en

  Laparoscopy is a valuable and safe method to treat patients with MALS. […] Treatments consist of celiac axis release performed laparoscopically or robotically, and intraluminal stenting. […] Confirmation of diagnosis of MALS requires interdisciplinary methods and a specialist, and is based on clinical presentation and ultrasonography, computed tomography or magnetic resonance imaging. […] Several techniques are used to treat MALS, and both endovascular and surgical procedures are used. The first option is angioplasty with stent implantation, which can be performed as a single or hybrid treatment. […] Only a small number of studies with a low number of patients discuss the laparoscopic treatment of MALS, and most are case reports. […] Laparoscopy is characterized by a higher percentage of immediate postoperative symptom relief (96% vs. 78% for open) and a lower late recurrence rate (5.7% vs. 6.8% for open). Therefore, laparoscopy is a safe method that leads to earlier recovery compared with open technique.

• #13 Median Arcuate Ligament Syndrome (MALS) | University Hospitals | University Hospitals

  https://www.uhhospitals.org/services/heart-and-vascular-services/conditions-and-treatments/vascular-disease/median-arcuate-ligament-syndrome

  Most people who get this procedure report that their MALS symptoms, such as pain with eating and chronic pain in the upper middle stomach area, significantly improve after their surgery. Patients generally are able to return to their normal activities within two weeks. […] Some people with MALS must get traditional surgery instead. In the open technique, a vascular surgeon makes a large incision down the middle of the abdomen. People who have the open MALS release procedure may need to stay in the hospital for three to five days to recover. These patients can usually return to their normal activities within four to six weeks. […] Most people who have surgery for MALS will have a duplex ultrasound a month after their procedure to check to see that there is no further compression of the median arcuate ligament.

• #14 How Do You Fix Median Arcuate Ligament Syndrome (MALS)?

  https://www.laparoscopicsurgeons.com/blog/how-do-you-fix-median-arcuate-ligament-syndrome-mals.html

  Robotic surgery is an even more advanced option for treating MALS. […] During robotic surgery, the median arcuate ligament is carefully divided to relieve the compression on the celiac artery. […] Robotic surgery is increasingly being adopted for MALS treatment because of these advantages, especially in complex cases where precision is paramount. […] Median Arcuate Ligament Syndrome can cause debilitating symptoms, but laparoscopic and robotic surgeries offer effective solutions for fixing the condition. By releasing the compression on the celiac artery, these minimally invasive techniques provide patients with symptom relief and a better quality of life.

• #15 Treatment of Median Arcuate Ligament Syndrome Via Traditional and Robotic Techniques

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3848179/

  Median arcuate ligament syndrome (MALS) is a rare entity characterized by extrinsic compression of the celiac artery and symptoms of postprandial epigastric pain, nausea, vomiting, and weight loss mimicking mesenteric ischemia. […] We present two patients diagnosed with MALS, the first treated with an open laparotomy by a vascular surgeon and the second using a robot assisted laparoscopic approach by a general surgeon with a vascular surgeon on standby. […] Both patients recovered without complications and experienced resolution of their symptoms. […] While the traditional open approach still dominates, minimally invasive techniques are increasing in frequency. […] A general surgeon, with a vascular surgeon on standby, undertook a robot assisted laparoscopic approach. […] The patient was discharged the following day without complications. […] On follow up, after two weeks, the patient had complete resolution of her symptoms with normal flow velocity of the celiac artery (184 cm/s). […] If symptoms persist, revascularization of the celiac artery by either endovascular stenting or bypass can be considered as secondary procedures.

• #16 UT Physicians | Median arcuate ligament syndrome (MALS)

  https://www.utphysicians.com/median-arcuate-ligament-syndrome/

  The standard treatment of MALS is the release of the celiac artery by open surgical or laparoscopic removal of portions of the median arcuate ligament and ganglionic tissue that surround or completely encase the celiac artery. Regardless of the specific approach, the operation requires meticulous release of the celiac artery by division of muscle fibers from the median arcuate ligament and surgical removal of the overlying lymphatic, ganglionic, and soft tissue. The term neurolysis is used to describe the removal of nerve and ganglionic tissue that surrounds the artery in the front, sides, and back. In some patients inflammation and scar tissue is also removed. There are three main types of surgeries to treat MALS, all of which have a role. Surgical treatments can be done using open, laparoscopic, or endovascular methods. Surgical treatment is aimed to reduce or eliminate pain and improve the quality of life for the patient.

• #17 UT Physicians | Median arcuate ligament syndrome (MALS)

  https://www.utphysicians.com/median-arcuate-ligament-syndrome/

  The standard treatment of MALS is the release of the celiac artery by open surgical or laparoscopic removal of portions of the median arcuate ligament and ganglionic tissue that surround or completely encase the celiac artery. Regardless of the specific approach, the operation requires meticulous release of the celiac artery by division of muscle fibers from the median arcuate ligament and surgical removal of the overlying lymphatic, ganglionic, and soft tissue. The term neurolysis is used to describe the removal of nerve and ganglionic tissue that surrounds the artery in the front, sides, and back. In some patients inflammation and scar tissue is also removed. There are three main types of surgeries to treat MALS, all of which have a role. Surgical treatments can be done using open, laparoscopic, or endovascular methods. Surgical treatment is aimed to reduce or eliminate pain and improve the quality of life for the patient.

• #18 Median arcuate ligament syndrome (MALS) – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/median-arcuate-ligament-syndrome-mals/diagnosis-treatment/drc-20505007

  Surgery is the only treatment for median arcuate ligament syndrome, also called MALS. Surgery for MALS can improve or reduce symptoms in most people. […] The most common surgical treatment is median arcuate ligament release, also called decompression. It’s usually done as an open surgery through a cut in the belly area. Sometimes it is done using a camera and small instruments passed through several smaller openings. This is called laparoscopic surgery. […] During decompression surgery, the surgeon cuts away parts of the median arcuate ligament. This reduces pressure on the celiac artery and nerves. The surgeon removes the nerves around the celiac artery and its branches. Bundles of nerves on each side of the celiac artery also may be removed. […] Some people with MALS also may need surgery to repair or replace a blocked celiac artery and restore blood flow.

• #19 Median arcuate ligament syndrome (MALS) | Altru Health System

  https://www.altru.org/health-library/conditions/median-arcuate-ligament-syndrome-mals

  Treatment involves surgery to release pressure from the ligament on the artery and nerves. […] Surgery is the only treatment for median arcuate ligament syndrome, also called MALS. Surgery for MALS can improve or reduce symptoms in most people. […] The most common surgical treatment is median arcuate ligament release, also called decompression. It’s usually done as an open surgery through a cut in the belly area. Sometimes it is done using a camera and small instruments passed through several smaller openings. This is called laparoscopic surgery. […] During decompression surgery, the surgeon cuts away parts of the median arcuate ligament. This reduces pressure on the celiac artery and nerves. The surgeon removes the nerves around the celiac artery and its branches. Bundles of nerves on each side of the celiac artery also may be removed.

• #20 UT Physicians | Median arcuate ligament syndrome (MALS)

  https://www.utphysicians.com/median-arcuate-ligament-syndrome/

  Laparoscopic release of the celiac artery requires small holes to introduce the camera and surgical instruments without the larger incision. The surgeon works with camera visualization using scissors and cautery. Although the same steps are performed, the operation has the advantage of smaller incisions and the potential disadvantage of risk of bleeding complications or a less thorough release of the ligament. It is critical that the laparoscopic approach is performed by a surgeon with extensive experience in laparoscopy and familiarity with surgical dissection of the celiac artery. Moreover, if laparoscopy is selected, the procedure needs to be performed in surgical environment and by a team that is ready to perform conversion and arterial repair, if needed. […] Endovascular approach is not recommended as a stand-alone therapy because the muscle and ligament cause persistent compression of the artery, which typically recoils back to its compressed state after the balloon angioplasty. In fact, patients who are treated by angioplasty balloon and stent placement without prior surgical release of the ligament may experience complete occlusion or fracture of the stent due to the median arcuate ligament compression. Most often, endovascular approach is used in conjunction with previous laparoscopic or open surgical release to treat residual narrowing of the artery following the surgical release. In these cases, the procedure can be done under a local anesthetic with a small puncture in the groin artery. A catheter is introduced into the celiac artery and the narrowing is dilated with balloon angioplasty. Typically, a stent is also placed.

• #21 UT Physicians | Median arcuate ligament syndrome (MALS)

  https://www.utphysicians.com/median-arcuate-ligament-syndrome/

  Laparoscopic release of the celiac artery requires small holes to introduce the camera and surgical instruments without the larger incision. The surgeon works with camera visualization using scissors and cautery. Although the same steps are performed, the operation has the advantage of smaller incisions and the potential disadvantage of risk of bleeding complications or a less thorough release of the ligament. It is critical that the laparoscopic approach is performed by a surgeon with extensive experience in laparoscopy and familiarity with surgical dissection of the celiac artery. Moreover, if laparoscopy is selected, the procedure needs to be performed in surgical environment and by a team that is ready to perform conversion and arterial repair, if needed. […] Endovascular approach is not recommended as a stand-alone therapy because the muscle and ligament cause persistent compression of the artery, which typically recoils back to its compressed state after the balloon angioplasty. In fact, patients who are treated by angioplasty balloon and stent placement without prior surgical release of the ligament may experience complete occlusion or fracture of the stent due to the median arcuate ligament compression. Most often, endovascular approach is used in conjunction with previous laparoscopic or open surgical release to treat residual narrowing of the artery following the surgical release. In these cases, the procedure can be done under a local anesthetic with a small puncture in the groin artery. A catheter is introduced into the celiac artery and the narrowing is dilated with balloon angioplasty. Typically, a stent is also placed.

• #22 Median Arcuate Ligament Syndrome (MALS) | University Hospitals | University Hospitals

  https://www.uhhospitals.org/services/heart-and-vascular-services/conditions-and-treatments/vascular-disease/median-arcuate-ligament-syndrome

  Some patients continue to have a narrowing of the celiac artery following surgery because of the buildup of scar tissue. This typically does not cause symptoms can be treated with medications or other nonsurgical methods or, more rarely, another celiac plexus block. In addition, sometimes stenting of the celiac axis or other endovascular procedures may be needed. […] A small percentage of people who experience repeated episodes of MALS may be candidates for surgical release of scar tissue, typically done as an open operation.

• #23 UT Physicians | Median arcuate ligament syndrome (MALS)

  https://www.utphysicians.com/median-arcuate-ligament-syndrome/

  Laparoscopic release of the celiac artery requires small holes to introduce the camera and surgical instruments without the larger incision. The surgeon works with camera visualization using scissors and cautery. Although the same steps are performed, the operation has the advantage of smaller incisions and the potential disadvantage of risk of bleeding complications or a less thorough release of the ligament. It is critical that the laparoscopic approach is performed by a surgeon with extensive experience in laparoscopy and familiarity with surgical dissection of the celiac artery. Moreover, if laparoscopy is selected, the procedure needs to be performed in surgical environment and by a team that is ready to perform conversion and arterial repair, if needed. […] Endovascular approach is not recommended as a stand-alone therapy because the muscle and ligament cause persistent compression of the artery, which typically recoils back to its compressed state after the balloon angioplasty. In fact, patients who are treated by angioplasty balloon and stent placement without prior surgical release of the ligament may experience complete occlusion or fracture of the stent due to the median arcuate ligament compression. Most often, endovascular approach is used in conjunction with previous laparoscopic or open surgical release to treat residual narrowing of the artery following the surgical release. In these cases, the procedure can be done under a local anesthetic with a small puncture in the groin artery. A catheter is introduced into the celiac artery and the narrowing is dilated with balloon angioplasty. Typically, a stent is also placed.

• #24 UT Physicians | Median arcuate ligament syndrome (MALS)

  https://www.utphysicians.com/median-arcuate-ligament-syndrome/

  Laparoscopic release of the celiac artery requires small holes to introduce the camera and surgical instruments without the larger incision. The surgeon works with camera visualization using scissors and cautery. Although the same steps are performed, the operation has the advantage of smaller incisions and the potential disadvantage of risk of bleeding complications or a less thorough release of the ligament. It is critical that the laparoscopic approach is performed by a surgeon with extensive experience in laparoscopy and familiarity with surgical dissection of the celiac artery. Moreover, if laparoscopy is selected, the procedure needs to be performed in surgical environment and by a team that is ready to perform conversion and arterial repair, if needed. […] Endovascular approach is not recommended as a stand-alone therapy because the muscle and ligament cause persistent compression of the artery, which typically recoils back to its compressed state after the balloon angioplasty. In fact, patients who are treated by angioplasty balloon and stent placement without prior surgical release of the ligament may experience complete occlusion or fracture of the stent due to the median arcuate ligament compression. Most often, endovascular approach is used in conjunction with previous laparoscopic or open surgical release to treat residual narrowing of the artery following the surgical release. In these cases, the procedure can be done under a local anesthetic with a small puncture in the groin artery. A catheter is introduced into the celiac artery and the narrowing is dilated with balloon angioplasty. Typically, a stent is also placed.

• #25 Median arcuate ligament syndrome (MALS) – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/median-arcuate-ligament-syndrome-mals/diagnosis-treatment/drc-20505007

  Surgery is the only treatment for median arcuate ligament syndrome, also called MALS. Surgery for MALS can improve or reduce symptoms in most people. […] The most common surgical treatment is median arcuate ligament release, also called decompression. It’s usually done as an open surgery through a cut in the belly area. Sometimes it is done using a camera and small instruments passed through several smaller openings. This is called laparoscopic surgery. […] During decompression surgery, the surgeon cuts away parts of the median arcuate ligament. This reduces pressure on the celiac artery and nerves. The surgeon removes the nerves around the celiac artery and its branches. Bundles of nerves on each side of the celiac artery also may be removed. […] Some people with MALS also may need surgery to repair or replace a blocked celiac artery and restore blood flow.

• #26 Laparoscopic treatment of median arcuate ligament syndrome

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6557235/

  Compared to laparotomy, laparoscopic surgery may reduce surgical trauma and patient hospitalization, improve the safety of the surgery, and ultrasound could be used to assist in confirming the opening of the celiac trunk. […] Jimenez et al. reviewed the English literature on MALS surgery and laparoscopic surgery between 1963 and 2012 and they analyzed postoperative outcomes in 400 patients, procedure details, and intraoperative and postoperative complications. The procedure was mainly the release of the median arcuate ligament; the celiac ganglia were removed or blood flow in the celiac trunk was restored in some patients. Results indicated that 85% of patients had immediate postoperative relief of symptoms, and the rate of symptom recurrence was 6.8% in patients who underwent a laparotomy and 5.7% in those who underwent laparoscopic surgery. […] Laparoscopic surgery is performed at the authors facility to treat MALS, and patient prognosis is good.

• #27 SciELO Brazil – Treatment of median arcuate ligament syndrome: outcome of laparoscopic approach Treatment of median arcuate ligament syndrome: outcome of laparoscopic approach

  https://www.scielo.br/j/abcd/a/c9qSc6Kyg5gkthJyPnMs33q/

  Laparoscopic decompression of the celiac trunk has become the standard treatment of MALS. […] Laparoscopic treatment of MALS compared with open operation has several advantages, including less morbidity, less postoperative pain, shorter recovery period, less adhesions, less blood loss, faster return to normal activities, and better cosmetic results. […] Sustained symptom relief has been reported in 80% to 100% of patients with MALS who underwent surgical decompression, depending on several factors, including patients selection and severity of celiac trunk stenosis.

• #28 Median arcuate ligament syndrome – Wikipedia

  https://en.wikipedia.org/wiki/Median_arcuate_ligament_syndrome

  Treatment is generally surgical, the mainstay being open or laparoscopic division, or separation, of the median arcuate ligament combined with removal of the celiac ganglia. The majority of patients benefit from surgical intervention. Poorer responses to treatment tend to occur in patients of older age, those with a psychiatric condition or who use alcohol, have abdominal pain unrelated to meals, or who have not experienced weight loss. […] Decompression of the celiac artery is the general approach to treatment of MALS. The mainstay of treatment involves open or laparoscopic surgery approaches to divide, or separate, the median arcuate ligament to relieve the compression of the celiac artery. This is combined with removal of the celiac ganglia and evaluation of blood flow through the celiac artery, for example by intraoperative duplex ultrasound. If blood flow is poor, celiac artery revascularization is usually attempted; methods of revascularization include aortoceliac bypass, patch angioplasty, and others.

• #29 Median arcuate ligament syndrome (MALS) – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/median-arcuate-ligament-syndrome-mals/diagnosis-treatment/drc-20505007

  If you have MALS release surgery, you usually stay in the hospital for 2 to 3 days. You may have an ultrasound or a CT scan about a month after surgery to make sure that blood flow is fully restored. You may need to see a nutritionist to help with returning to a healthy diet. This is particularly helpful if you have not been eating or have lost a lot of weight.

• #30 Median arcuate ligament syndrome (MALS) | Altru Health System

  https://www.altru.org/health-library/conditions/median-arcuate-ligament-syndrome-mals

  Some people with MALS also may need surgery to repair or replace a blocked celiac artery and restore blood flow. […] If you have MALS release surgery, you usually stay in the hospital for 2 to 3 days. You may have an ultrasound or a CT scan about a month after surgery to make sure that blood flow is fully restored. You may need to see a nutritionist to help with returning to a healthy diet. This is particularly helpful if you have not been eating or have lost a lot of weight.

• #31 Median arcuate ligament syndrome (MALS) – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/median-arcuate-ligament-syndrome-mals/diagnosis-treatment/drc-20505007

  If you have MALS release surgery, you usually stay in the hospital for 2 to 3 days. You may have an ultrasound or a CT scan about a month after surgery to make sure that blood flow is fully restored. You may need to see a nutritionist to help with returning to a healthy diet. This is particularly helpful if you have not been eating or have lost a lot of weight.

• #32 Median arcuate ligament syndrome (MALS) – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/median-arcuate-ligament-syndrome-mals/diagnosis-treatment/drc-20505007

  If you have MALS release surgery, you usually stay in the hospital for 2 to 3 days. You may have an ultrasound or a CT scan about a month after surgery to make sure that blood flow is fully restored. You may need to see a nutritionist to help with returning to a healthy diet. This is particularly helpful if you have not been eating or have lost a lot of weight.

• #33 Median Arcuate Ligament Syndrome Treatment In India | MALS

  https://drjasmeetahluwalia.com/median-arcuate-ligament-syndrome-treatment-in-india/

  Physical therapy will be given by the doctors after the surgery; like a walk around the room. Not only this, the patient is under the proper observation of the medical staff and the doctor will make sure about the digestive tract is functioning normally. A Diet along with a few medications is recommended for the patient. Once the patient returns to a normal diet and has no problem digesting, the patient is discharged from the hospital.

• #34 Median arcuate ligament syndrome: When to consider the diagnosis and management options

  https://www1.racgp.org.au/ajgp/2024/supplement-december/median-arcuate-ligament-syndrome

  If appropriate, intervention for MALS requires a multidisciplinary approach, including vascular surgery, general surgery, pain specialists and interventional radiology. […] Coeliac plexus block is a non-surgical option for relief from MALS that can also aide as a diagnostic test. Coeliac plexus block involves an interventional radiologist or a pain specialist injecting local anaesthetic or a neurolytic agent directly into the coeliac plexus with imaging guidance. If the patient receives transient relief from intervention, this further supports a MALS diagnosis and might encourage surgeons to proceed to surgery. […] The surgical treatment of MALS includes decompressing the artery and performing a coeliac ganglionectomy. Decompression of the coeliac artery was traditionally performed through a laparotomy but is now more commonly performed via laparoscopically or robot-assisted laparoscopic release. In some cases, however, coeliac artery reconstruction might be indicated.

• #35 Median arcuate ligament syndrome: When to consider the diagnosis and management options

  https://www1.racgp.org.au/ajgp/2024/supplement-december/median-arcuate-ligament-syndrome

  If appropriate, intervention for MALS requires a multidisciplinary approach, including vascular surgery, general surgery, pain specialists and interventional radiology. […] Coeliac plexus block is a non-surgical option for relief from MALS that can also aide as a diagnostic test. Coeliac plexus block involves an interventional radiologist or a pain specialist injecting local anaesthetic or a neurolytic agent directly into the coeliac plexus with imaging guidance. If the patient receives transient relief from intervention, this further supports a MALS diagnosis and might encourage surgeons to proceed to surgery. […] The surgical treatment of MALS includes decompressing the artery and performing a coeliac ganglionectomy. Decompression of the coeliac artery was traditionally performed through a laparotomy but is now more commonly performed via laparoscopically or robot-assisted laparoscopic release. In some cases, however, coeliac artery reconstruction might be indicated.

• #36 Median arcuate ligament syndrome: When to consider the diagnosis and management options

  https://www1.racgp.org.au/ajgp/2024/supplement-december/median-arcuate-ligament-syndrome

  If appropriate, intervention for MALS requires a multidisciplinary approach, including vascular surgery, general surgery, pain specialists and interventional radiology. […] Coeliac plexus block is a non-surgical option for relief from MALS that can also aide as a diagnostic test. Coeliac plexus block involves an interventional radiologist or a pain specialist injecting local anaesthetic or a neurolytic agent directly into the coeliac plexus with imaging guidance. If the patient receives transient relief from intervention, this further supports a MALS diagnosis and might encourage surgeons to proceed to surgery. […] The surgical treatment of MALS includes decompressing the artery and performing a coeliac ganglionectomy. Decompression of the coeliac artery was traditionally performed through a laparotomy but is now more commonly performed via laparoscopically or robot-assisted laparoscopic release. In some cases, however, coeliac artery reconstruction might be indicated.

• #37 Median Arcuate Ligament Syndrome – Practical Gastro

  https://practicalgastro.com/2015/02/05/median-arcuate-ligament-syndrome/

  Endoscopic ultrasound (EUS) can be a good predictor of response to surgical decompression and a good way to strengthen the diagnosis of MALS. […] Another role for EUS is EUS-guided injection of xylocaine and alcohol into the celiac ganglion to further enhance the results of post-surgical decompression when there is some remaining abdominal pain component. […] Surgical decompression relieves abdominal pain, nausea, vomiting, gastric dysrhythmia, and gastroparesis in most patients but a subset have some continuing pain component. […] There are new roles for EUS in the management of MALS.

• #38 Median Arcuate Ligament Syndrome | Applied Radiology

  https://appliedradiology.com/articles/median-arcuate-ligament-syndrome

  A celiac plexus block (CPB) is another treatment option. In a study of 103 cases using CPB, 84% of patients reported lower post procedure pain scores, with the average score dropping from 6.3 to 0.9 on a 0-10 scale. […] Median arcuate ligament syndrome is important to keep in mind when presented with patient complaints of generalized abdominal symptoms, as it can lead to debilitating signs and symptoms, including marked weight loss. Laparoscopic surgery is typically the therapeutic option.

• #39 MALS Diagnosis & Treatment | Contact Us | Birmingham HPB

  https://birminghamhpbclinic.co.uk/median-arcuate-ligament-syndrome-mals-diagnosis-treatment/

  Once a diagnosis is confirmed, several treatment options are available to manage MALS: […] Patients are often advised to make specific dietary and lifestyle changes to alleviate their symptoms. Recommendations may include eating smaller, more frequent meals, and avoiding foods that trigger discomfort. […] Some individuals with MALS may benefit from medication to control pain or manage associated conditions, such as irritable bowel syndrome. […] In certain cases, a minimally invasive procedure known as angioplasty with stent placement may be recommended. This procedure can alleviate the compression of the celiac artery, thereby reducing symptoms. […] When other treatment approaches prove ineffective, surgical intervention may become necessary. During surgery, the ligament causing the compression is divided, providing relief to the celiac artery. […] Many patients find that a multidisciplinary approach is the most effective. This may involve collaboration between gastroenterologists, vascular surgeons, and pain management specialists, ensuring comprehensive care and support for individuals with MALS.

• #40 MALS: Causes, Symptoms & Treatment | Dr. Joshua Tierney

  https://www.drjoshuatierney.com/conditions/vascular/mals/

  Median Arcuate Ligament Syndrome (MALS) is a rare but potentially debilitating condition caused by the compression of the celiac artery by the median arcuate ligament. […] Early detection and appropriate treatment can significantly improve the quality of life for those affected. […] Lifestyle changes include eating smaller, more frequent meals and avoiding foods that trigger symptoms. […] Surgical intervention may be necessary if conservative treatments are ineffective. Laparoscopic surgery for MALS, such as the laparoscopic release of the median arcuate ligament, is a common approach. […] Effective management of MALS often involves a team of specialists, including gastroenterologists, vascular surgeons, and pain management experts, working together to provide comprehensive and personalized care.

• #41 MALS Diagnosis & Treatment | Contact Us | Birmingham HPB

  https://birminghamhpbclinic.co.uk/median-arcuate-ligament-syndrome-mals-diagnosis-treatment/

  Once a diagnosis is confirmed, several treatment options are available to manage MALS: […] Patients are often advised to make specific dietary and lifestyle changes to alleviate their symptoms. Recommendations may include eating smaller, more frequent meals, and avoiding foods that trigger discomfort. […] Some individuals with MALS may benefit from medication to control pain or manage associated conditions, such as irritable bowel syndrome. […] In certain cases, a minimally invasive procedure known as angioplasty with stent placement may be recommended. This procedure can alleviate the compression of the celiac artery, thereby reducing symptoms. […] When other treatment approaches prove ineffective, surgical intervention may become necessary. During surgery, the ligament causing the compression is divided, providing relief to the celiac artery. […] Many patients find that a multidisciplinary approach is the most effective. This may involve collaboration between gastroenterologists, vascular surgeons, and pain management specialists, ensuring comprehensive care and support for individuals with MALS.

• #42 Non-Surgical Management of MALS Exploring Conservative Treatment Options – The University of Chicago MALS Program

  https://www.ucmals.com/non-surgical-management-of-mals-exploring/

  The treatment of Median Arcuate Ligament Syndrome (MALS) can be challenging, as it often requires a multidisciplinary approach. […] While surgical interventions have traditionally been the mainstay of management, there is growing interest in exploring conservative, non-surgical options for patients with MALS. […] When it comes to the management of MALS, conservative treatment options play a crucial role in improving patient outcomes. […] These non-surgical approaches focus on addressing the underlying causes of MALS and alleviating symptoms, without the need for invasive procedures. […] One of the key non-surgical options for managing MALS is lifestyle modifications. […] Additionally, physical therapy and chiropractic care can also be beneficial in improving vascular flow and reducing pain.

• #43 Integrative medicine management of median arcuate ligament syndrome: a case report – Pintas – Longhua Chinese Medicine

  https://lcm.amegroups.org/article/view/8882/html

  Acupuncture may provide adjunctive management and pain relief for patients with Median Arcuate Ligament Syndrome (MALS) […] Acupuncture may play a role in mitigating symptoms and improving gastric motility in this patient population. […] Non-surgical treatment strategies for MALS are limited; acupuncture may provide symptomatic relief in refractory cases or when surgery is not readily available. […] While definitive treatment includes decompression of the MAL (e.g., via robotic, laparoscopic, endoscopic retroperitoneal or open surgical intervention) with the possibility for celiac ganglionectomy, TCM may offer a robust non-pharmacologic approach to pain control. […] Acupuncture offers a unique adjunctive treatment to patients before surgical intervention or during the post-operative recovery phase.

• #44 Non-Surgical Management of MALS Exploring Conservative Treatment Options – The University of Chicago MALS Program

  https://www.ucmals.com/non-surgical-management-of-mals-exploring/

  It is important to note that non-surgical options may not completely eliminate symptoms in all cases of MALS. […] Therefore, it is crucial to work closely with a healthcare professional to develop a personalized management plan for MALS. […] Non-surgical options for the management of MALS include dietary modifications, physical therapy, and pain management techniques. […] These options can help alleviate symptoms and improve overall well-being for individuals living with MALS. […] In some cases, dietary modifications may be recommended to help manage symptoms and improve liver function. […] These can include medications to reduce inflammation, control cholesterol levels, or manage complications such as diabetes or high blood pressure. […] Regular monitoring and follow-up with healthcare professionals are important in the management of MALS. […] This may involve regular blood tests to assess liver function, imaging tests to monitor changes in the liver, and ongoing communication with a healthcare team to address any concerns or changes in symptoms.

• #45 Team Approach | National MALS Foundation

  https://www.malsfoundation.org/team-approach

  MALS is an isolating medical condition because it can be challenging to diagnose, and because its rarity means that very few clinicians have first-hand knowledge or are up to date on the latest research. […] The team approach is the best approach to managing MALS symptoms, securing a MALS diagnosis, finding the right surgeon, and having strong follow-up care post-surgery. […] It is critical to select a surgeon who will follow you over the long term. […] Transition of care after surgery is important to consider. […] MALS symptoms and surgery are complicated. The celiac artery can recompress after release of the median arcuate ligament causing renewed symptoms. This recurrence of symptoms is not necessarily a reflection on the skill of your original surgeon. The best surgeons acknowledge that MALS surgery might not resolve symptoms and that further interventions might be necessary.

• #46 Median arcuate ligament syndrome: When to consider the diagnosis and management options

  https://www1.racgp.org.au/ajgp/2024/supplement-december/median-arcuate-ligament-syndrome

  If appropriate, intervention for MALS requires a multidisciplinary approach, including vascular surgery, general surgery, pain specialists and interventional radiology. […] Coeliac plexus block is a non-surgical option for relief from MALS that can also aide as a diagnostic test. Coeliac plexus block involves an interventional radiologist or a pain specialist injecting local anaesthetic or a neurolytic agent directly into the coeliac plexus with imaging guidance. If the patient receives transient relief from intervention, this further supports a MALS diagnosis and might encourage surgeons to proceed to surgery. […] The surgical treatment of MALS includes decompressing the artery and performing a coeliac ganglionectomy. Decompression of the coeliac artery was traditionally performed through a laparotomy but is now more commonly performed via laparoscopically or robot-assisted laparoscopic release. In some cases, however, coeliac artery reconstruction might be indicated.

• #47 MALS: Causes, Symptoms & Treatment | Dr. Joshua Tierney

  https://www.drjoshuatierney.com/conditions/vascular/mals/

  Median Arcuate Ligament Syndrome (MALS) is a rare but potentially debilitating condition caused by the compression of the celiac artery by the median arcuate ligament. […] Early detection and appropriate treatment can significantly improve the quality of life for those affected. […] Lifestyle changes include eating smaller, more frequent meals and avoiding foods that trigger symptoms. […] Surgical intervention may be necessary if conservative treatments are ineffective. Laparoscopic surgery for MALS, such as the laparoscopic release of the median arcuate ligament, is a common approach. […] Effective management of MALS often involves a team of specialists, including gastroenterologists, vascular surgeons, and pain management experts, working together to provide comprehensive and personalized care.

• #48 Median arcuate ligament syndrome: Incidental finding or real problem? | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/88/3/140

  It was not clear if her symptoms were related to artery compression or to a severe form of gastritis or peptic ulcer disease, with MALS as an incidental finding. […] She was subsequently evaluated by a gastroenterologist and a general surgeon for possible laparoscopic release of the ligament. […] The surgeon did not attribute her abdominal pain to MALS and did not recommend surgery. […] Laparoscopic release of the arcuate ligament has become a widely accepted treatment. […] Endovascular therapy may be necessary as well, given the possible recurrence of stenosis. […] Multidisciplinary assessment by a general surgeon, vascular surgeon, radiologist, and gastroenterologist is helpful. […] Cienfuegos et al offered the following selection criteria for laparoscopic treatment: young woman, intense postprandial pain, greater than 70% stenosis of the trunk, and development of collateral circulation.

• #49 Caring for kids with MALS: It’s not all in their head – UChicago Medicine

  https://www.uchicagomedicine.org/forefront/pediatrics-articles/2024/january/mals-not-all-in-their-head

  Our multidisciplinary program allows us to identify those patients whose pain is most likely caused by the compression and who will benefit from surgery, said Mak. […] After reviewing each childs medical and psychological findings, the MALS team determines whether surgery and a presurgical mental health intervention are warranted. […] Most of the time we recommend individual cognitive behavioral therapy, which can be done at Comer or elsewhere. But we might also refer a child to a pain management program to learn coping skills related to pain, said Drossos. […] Surgery to release the median arcuate ligament in children is nearly always performed laparoscopically at Comer, and jointly by Mak and Skelly, a unique pairing of surgeons. […] For 70% to 80% of children with MALS, surgically releasing the median arcuate ligament with neurolysis results in diminished abdominal pain and improved quality of life. But about one-third of patients have persistent or recurrent abdominal pain. A second surgery may be warranted if the duplex ultrasound reveals the presence of scar tissue.

• #50 Caring for kids with MALS: It’s not all in their head – UChicago Medicine

  https://www.uchicagomedicine.org/forefront/pediatrics-articles/2024/january/mals-not-all-in-their-head

  Our multidisciplinary program allows us to identify those patients whose pain is most likely caused by the compression and who will benefit from surgery, said Mak. […] After reviewing each childs medical and psychological findings, the MALS team determines whether surgery and a presurgical mental health intervention are warranted. […] Most of the time we recommend individual cognitive behavioral therapy, which can be done at Comer or elsewhere. But we might also refer a child to a pain management program to learn coping skills related to pain, said Drossos. […] Surgery to release the median arcuate ligament in children is nearly always performed laparoscopically at Comer, and jointly by Mak and Skelly, a unique pairing of surgeons. […] For 70% to 80% of children with MALS, surgically releasing the median arcuate ligament with neurolysis results in diminished abdominal pain and improved quality of life. But about one-third of patients have persistent or recurrent abdominal pain. A second surgery may be warranted if the duplex ultrasound reveals the presence of scar tissue.

• #51 MALS: Median Arcuate Ligament Syndrome Overview

  https://www.verywellhealth.com/mals-median-arcuate-ligament-syndrome-4691027

  Due to the high risk of bleeding during MALS surgery there are often two surgeons working together during the procedure; one is usually a vascular surgeon. […] Potential complications of celiac artery decompression include: Hemorrhage and possible blood transfusions, Incomplete celiac artery release, Recurrence of symptoms following surgery, Infection, Complications of general anesthesia including malignant hyperthermia, difficulty breathing or even death, Diarrhea, nausea, and self-limiting pancreatitis following surgery. […] Following a celiac artery decompression, most patients remain in the hospital approximately two to three days. […] Studies show that approximately 60% to 80% of patients who underwent celiac artery decompression experienced relief of their symptoms following surgery.

• #52 MALS: Median Arcuate Ligament Syndrome Overview

  https://www.verywellhealth.com/mals-median-arcuate-ligament-syndrome-4691027

  Due to the high risk of bleeding during MALS surgery there are often two surgeons working together during the procedure; one is usually a vascular surgeon. […] Potential complications of celiac artery decompression include: Hemorrhage and possible blood transfusions, Incomplete celiac artery release, Recurrence of symptoms following surgery, Infection, Complications of general anesthesia including malignant hyperthermia, difficulty breathing or even death, Diarrhea, nausea, and self-limiting pancreatitis following surgery. […] Following a celiac artery decompression, most patients remain in the hospital approximately two to three days. […] Studies show that approximately 60% to 80% of patients who underwent celiac artery decompression experienced relief of their symptoms following surgery.

• #53 Median Arcuate Ligament Syndrome (MALS) | University Hospitals | University Hospitals

  https://www.uhhospitals.org/services/heart-and-vascular-services/conditions-and-treatments/vascular-disease/median-arcuate-ligament-syndrome

  Some patients continue to have a narrowing of the celiac artery following surgery because of the buildup of scar tissue. This typically does not cause symptoms can be treated with medications or other nonsurgical methods or, more rarely, another celiac plexus block. In addition, sometimes stenting of the celiac axis or other endovascular procedures may be needed. […] A small percentage of people who experience repeated episodes of MALS may be candidates for surgical release of scar tissue, typically done as an open operation.

• #54 Median Arcuate Ligament Syndrome (MALS) | University Hospitals | University Hospitals

  https://www.uhhospitals.org/services/heart-and-vascular-services/conditions-and-treatments/vascular-disease/median-arcuate-ligament-syndrome

  Some patients continue to have a narrowing of the celiac artery following surgery because of the buildup of scar tissue. This typically does not cause symptoms can be treated with medications or other nonsurgical methods or, more rarely, another celiac plexus block. In addition, sometimes stenting of the celiac axis or other endovascular procedures may be needed. […] A small percentage of people who experience repeated episodes of MALS may be candidates for surgical release of scar tissue, typically done as an open operation.

• #55 Treatment of Median Arcuate Ligament Syndrome Via Traditional and Robotic Techniques

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3848179/

  Median arcuate ligament syndrome (MALS) is a rare entity characterized by extrinsic compression of the celiac artery and symptoms of postprandial epigastric pain, nausea, vomiting, and weight loss mimicking mesenteric ischemia. […] We present two patients diagnosed with MALS, the first treated with an open laparotomy by a vascular surgeon and the second using a robot assisted laparoscopic approach by a general surgeon with a vascular surgeon on standby. […] Both patients recovered without complications and experienced resolution of their symptoms. […] While the traditional open approach still dominates, minimally invasive techniques are increasing in frequency. […] A general surgeon, with a vascular surgeon on standby, undertook a robot assisted laparoscopic approach. […] The patient was discharged the following day without complications. […] On follow up, after two weeks, the patient had complete resolution of her symptoms with normal flow velocity of the celiac artery (184 cm/s). […] If symptoms persist, revascularization of the celiac artery by either endovascular stenting or bypass can be considered as secondary procedures.

• #56 Caring for kids with MALS: It’s not all in their head – UChicago Medicine

  https://www.uchicagomedicine.org/forefront/pediatrics-articles/2024/january/mals-not-all-in-their-head

  Our multidisciplinary program allows us to identify those patients whose pain is most likely caused by the compression and who will benefit from surgery, said Mak. […] After reviewing each childs medical and psychological findings, the MALS team determines whether surgery and a presurgical mental health intervention are warranted. […] Most of the time we recommend individual cognitive behavioral therapy, which can be done at Comer or elsewhere. But we might also refer a child to a pain management program to learn coping skills related to pain, said Drossos. […] Surgery to release the median arcuate ligament in children is nearly always performed laparoscopically at Comer, and jointly by Mak and Skelly, a unique pairing of surgeons. […] For 70% to 80% of children with MALS, surgically releasing the median arcuate ligament with neurolysis results in diminished abdominal pain and improved quality of life. But about one-third of patients have persistent or recurrent abdominal pain. A second surgery may be warranted if the duplex ultrasound reveals the presence of scar tissue.

• #57 Caring for kids with MALS: It’s not all in their head – UChicago Medicine

  https://www.uchicagomedicine.org/forefront/pediatrics-articles/2024/january/mals-not-all-in-their-head

  We can do an angioplasty to help the artery remodel, said Skelly. Or, for some patients, a pain specialist will perform a celiac plexus block to temporarily deaden the nerves. […] We are actively involved with the MALS Foundation, a nonprofit started by several of our patients and parents of patients, to increase awareness and education of patients and providers about MALS, Skelly said. Chronic abdominal pain is devastating for kids. If surgery can resolve their pain, it can change the trajectory of their lives.

• #58 Median arcuate ligament syndrome (MALS) – Augusta HealthSearchClose SearchSearch IconSearch IconClose Search IconMobile Menu IconMobile Menu Close IconInstagramFacebookTwitterYoutube

  https://www.augustahealth.com/disease/median-arcuate-ligament-syndrome-mals/

  Treatment involves surgery to release (decompress) the ligament and restore blood flow through the artery. […] Surgery is the only treatment option for MALS. The most common procedure is called median arcuate ligament release, or median arcuate ligament decompression. It’s usually done as an open surgery but sometimes can be done as a minimally invasive (laparoscopic or robotic) procedure. […] While you’re under general anesthesia, a surgeon divides the median arcuate ligament and network of nerves in the stomach area (celiac plexus). Doing so provides more room for the artery, restores blood flow and relieves pressure on the nerves. […] Some people with MALS may need an open surgery to repair or replace a blocked celiac artery and fully restore blood flow (revascularization). […] If you have MALS release surgery, you’ll usually stay in the hospital for two to three days. You’ll need an ultrasound about a month after surgery to confirm that blood flow through the celiac artery is fully restored. Several studies have shown that surgery to release the median arcuate ligament is safe, even in children with MALS. It often results in immediate pain relief and improves the person’s quality of life.

• #59 How Do You Fix Median Arcuate Ligament Syndrome (MALS)?

  https://www.laparoscopicsurgeons.com/blog/how-do-you-fix-median-arcuate-ligament-syndrome-mals.html

  Median Arcuate Ligament Syndrome (MALS) is a rare condition in which the median arcuate ligament, a band of tissue in the diaphragm, compresses the celiac artery, a major blood vessel that supplies oxygenated blood to the upper abdominal organs. […] Fortunately, there are effective ways to address MALS and relieve its symptoms, primarily through surgery. […] The only effective way to fix MALS is through surgery. The goal of the surgery is to release the compression on the celiac artery by cutting or removing the median arcuate ligament. […] Laparoscopic surgery, also known as minimally invasive surgery, is one of the primary approaches used to treat MALS. […] The surgeon then uses specialized instruments to cut or remove the median arcuate ligament and free the celiac artery. […] Laparoscopic surgery offers a highly effective way to treat MALS while minimizing the impact on the patient’s body.

• #60 Treatment of Median Arcuate Ligament Syndrome Via Traditional and Robotic Techniques

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3848179/

  Median arcuate ligament syndrome (MALS) is a rare entity characterized by extrinsic compression of the celiac artery and symptoms of postprandial epigastric pain, nausea, vomiting, and weight loss mimicking mesenteric ischemia. […] We present two patients diagnosed with MALS, the first treated with an open laparotomy by a vascular surgeon and the second using a robot assisted laparoscopic approach by a general surgeon with a vascular surgeon on standby. […] Both patients recovered without complications and experienced resolution of their symptoms. […] While the traditional open approach still dominates, minimally invasive techniques are increasing in frequency. […] A general surgeon, with a vascular surgeon on standby, undertook a robot assisted laparoscopic approach. […] The patient was discharged the following day without complications. […] On follow up, after two weeks, the patient had complete resolution of her symptoms with normal flow velocity of the celiac artery (184 cm/s). […] If symptoms persist, revascularization of the celiac artery by either endovascular stenting or bypass can be considered as secondary procedures.

• #61

  https://journals.lww.com/jmas/fulltext/2024/20030/performing_median_arcuate_ligament_release_surgery.12.aspx

  Median arcuate ligament syndrome (MALS) is a rare condition characterized by persistent post-meal or post-exercise abdominal discomfort, often more pronounced during expiration. […] The primary treatment involved surgical decompression of the CA by releasing the MAL through either open or laparoscopic techniques. […] Surgical release of the MAL is the primary treatment for MALS, providing relief for many patients. However, long-term follow-up is essential as some patients may continue to experience symptoms post-surgery, necessitating further interventions. […] The definitive treatment for MALS involves surgically releasing the MAL to alleviate compression on the celiac plexus. […] The laparoscopic technique for MAL release has shown significant benefits, including improved visualisation of the CA, reduced morbidity and shorter post-operative hospital stays. In addition to open surgical procedures, both laparoscopic and endovascular techniques have gained traction over the past decade. […] Available evidence suggests that various treatment approaches, including laparoscopic and open ligament release and CA revascularisation (using both open and endovascular methods), can offer lasting relief from symptoms in most MALS-diagnosed patients.

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