MALS Laparoscopic Surgery | Median Arcuate Ligament Syndrome

Laparoscopic surgeon, Dr. Anthony Vine performs a minimally invasive procedure to treat Median Arcuate Ligament Syndrome (MALS), a rare condition in which a band of tissue in the lower part of the chest (median arcuate ligament), rests lower than normal and presses against the celiac artery and the celiac plexus nerves. 

Dr. Vine uses a technique called laparoscopic median arcuate ligament release to relieve the compression of the celiac artery and celiac plexus.

What This Laparoscopic Procedure Involves

He makes a tiny incision and inserts a tool called a trocar, which is similar to a hollow, small pen, into the upper abdomen, each less than a quarter or half inch long. Once in place, Dr. Vine uses this trocar to insert various surgical tools, whether it be a tiny laparoscope, a device with a camera and light, or other instruments including scissors, graspers, coagulators, and suturing devices. The camera offers a magnified view inside the abdominal cavity on a video monitor. The abdomen is inflated through the trocar with carbon dioxide. 

Releasing Pressure on the Celiac Artery and Celiac Plexus Nerves

Dr. Vine locates the median arcuate ligament, which is pressing down on the celiac artery and nearby celiac plexus nerves. He then carefully dissects and separates the ligament fibers to release pressure on the artery. Dr. Vine may also release or remove nerves around the celiac artery to further relieve pressure and pain. He then examines the artery, making sure it is no longer being compressed and blood is flowing properly.

If artery damage is severe, a stent may be required to improve blood flow. 

Benefits of Laparoscopic Surgery

• Less invasive – tiny incisions cause minimal damage to surrounding tissue and less blood loss.
• Minimal pain – smaller wounds mean little discomfort and less anesthesia needed.
• Barely visible scars – small incisions heal with little to no scarring.
• Faster recovery – patients heal more quickly than with open surgery, returning to their daily routine sooner.
• Ambulatory procedure – discharge the same day or after a brief hospital stay
• Lower risk of infection – smaller incisions reduce the chance of infection.
• Greater accuracy – the laparoscope provides a clear, magnified view for precise surgery.

For more information on the symptoms that may occur when the celiac artery and plexus are compressed, and how Dr. Vine diagnoses this condition, please visit our Median Arcuate Ligament Syndrome (MALS) page.