Laparoscopic surgery for median arcuate ligament syndrome: How to do it

Median arcuate ligament syndrome (MALS) is a rare condition caused by the compression of the celiac artery and plexus, often resulting in postprandial abdominal pain. Owing to limited awareness, it is frequently misdiagnosed or inadequately treated. We herein describe our surgical approach for the management of MALS. Patients presenting with unexplained abdominal symptoms or visceral aneurysms underwent Doppler ultrasonography and three-dimensional computed tomography angiography during both inspiration and expiration to diagnose MALS. Laparoscopic surgery was performed with a camera port placed 5-7 cm cranial to the umbilicus. After incising the diaphragmatic crura and dividing the median arcuate ligament, we dissected the celiac plexus and incised the vascular sheath to completely expose the celiac artery root. Among the most recent 34 patients, all symptomatic patients experienced symptom improvement. This approach appears to be a safe and effective treatment for MALS that provides significant symptom relief.