Outcomes of pediatric median arcuate ligament release: A single-center experience

Median arcuate ligament syndrome (MALS) is a rare condition caused by compression of the celiac artery by the median arcuate ligament. The surgical treatment for MALS is a median arcuate ligament release (MALR). While outcomes of MALR are well described in adults, pediatric data remain limited. Leveraging our extensive institutional experience, we sought to address this gap by reporting the largest single-institution cohort of pediatric patients undergoing MALR at a standalone children's hospital.

We performed a single-institution retrospective review of all patients who underwent laparoscopic MALR between January 2013 and December 2024 at a standalone children's hospital. We performed descriptive statistics and univariate analyses, with the primary outcome measure of freedom from treatment failure after MALR, defined as any symptom improvement after MALR without symptom recurrence.

Median arcuate ligament release was performed in 286 patients. Median age at surgery was 17.1 years. All cases were performed laparoscopically with one conversion to an open operation (0.3%). Mean postoperative length of stay was 1.5 days. Freedom from treatment failure was achieved in 61.2% of patients. Complications occurred in 2.4% of patients.

Our single-institution retrospective review describes the largest series of MALR at a freestanding children's hospital. We demonstrate a 61.2% freedom from treatment failure rate with minimal complications, supporting MALR as a safe therapeutic option for pediatric MALS. However, the substantial rate of postoperative symptom persistence or recurrence highlights the need for careful patient selection and thorough preoperative counseling regarding expected outcomes.