Median Arcuate Ligament Syndrome (MALS)

MALS surgery: the operation is not the same everywhere

Median arcuate ligament release can be performed open, laparoscopically, or robotically. Surgeons also differ in how much tissue they remove around the celiac artery. Some perform a wide celiac plexus neurolysis or celiac ganglionectomy in addition to cutting the ligament; others perform a more limited release focused on removing the external compression. In selected patients with persistent fixed celiac artery narrowing, arterial reconstruction or later endovascular treatment may also be considered.

There is not yet high-quality evidence proving that one operative approach or one amount of nerve dissection is best for every patient. The strongest recent comparative evidence suggests that robotic and laparoscopic approaches have similar overall complication and pain-resolution rates, while individual-center results vary substantially with surgeon technique and experience.

VCA has a separate detailed article, 'MALS Surgery: Open, Laparoscopic, Robotic, Celiac Plexus Neurolysis, and Long-Term Outcomes,' explaining these differences and the published outcome data.