Laparoscopic Release of the Median Arcuate Ligament for the Treatment of Median Arcuate Ligament Syndrome (mals)

Charles Thompson III, MD, Mayank Roy, MD, MRCS, Carolina Ampudia, MD, Pablo Marin, MD, Emanuele Lo Menzo, MD, Raul Rosenthal, MD

Cleveland Clinic Florida

Introduction: This video demonstrates the laparoscopic release of median arcuate ligament to treat the symptoms of MALS, a rare condition characterized by abdominal pain caused by an anatomiacal variance involving a compression of the celiac artery by the median arcuate ligament.

Case Report: A 57-year female presented with 4 months history of persistent weight loss, vomiting, and abdominal pain after meals. A preoperative MRI showed narrowing of the celiac trunk at its origin. After informed consent we performed a laparoscopic release of the median arcuate ligament. The abdominal cavity was accessed with a 12 mm optical trocar. Three additional 5 mm trocars were utilized. The left and right crus and posterior vagus nerve were identified and protected. The aortic hiatus was fully dissected, exposing the region of the celiac trunk. Subsequently, the left gastric artery was identified and traced back to the celiac trunk. A band of tissue was easily identified compressing the aorta, and it was released. Immediately, the celiac trunk appeared to resume its normal contour. There was minimal blood loss during the case. The patient was discharged on postoperative day four. On 1-month follow-up, the patient was doing well and tolerating an unrestricted diet without symptoms.

Conclusion: Laparoscopic release of the median arcuate ligament is a feasible and safe for the treatment of MALS in the hands of an experienced surgeon.

Session: Video ChannelDay 2

Program Number: V087

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