Laparoscopic Release of Median Arcuate Ligament Syndrome

Introduction: Median arcuate ligament syndrome (MALS) is a rare disorder characterized by celiac artery (CA) compression due to an abnormally positioned median arcuate ligament (MAL) or CA. 1 Patients experience debilitating postprandial abdominal pain, nausea, and weight loss, with an incidence of ∼2/100,000. Diagnosis remains challenging due to nonspecific symptoms, often requiring exclusion of other conditions. 2 , 3 Etiological debates persist between ischemic (foregut hypoperfusion) and neurogenic (celiac plexus irritation) theories. 4 , 5 Materials and Methods: This video article illustrates a laparoscopic MAL release in a 16-year-old female with chronic postprandial epigastric pain, nausea, vomiting, and 12% weight loss. Despite normal initial investigations (ultrasound, labs), Contrast enhanced CT (CECT) abdomen confirmed CA compression with post-stenotic dilatation. The video details key technical steps patient positioning, trocar placement, division of the MAL, identification and preservation of the celiac plexus, and intraoperative Doppler confirmation of restored CA flow. Results: The procedure was completed laparoscopically in 185 minutes without conversion. The patient resumed oral intake on postoperative day (POD) 1 with immediate symptom resolution. Discharge occurred on POD 3. At 1-year follow-up, she remained asymptomatic with normalized oral intake and weight gain. Conclusion: Laparoscopic MAL release is a safe, effective treatment for MALS, offering rapid symptom relief and minimal morbidity. This video highlights technical nuances critical to success, including meticulous ligament division and celiac plexus preservation. Early diagnosis via dedicated vascular imaging and timely minimally invasive intervention can significantly improve outcomes in this debilitating condition. Authors’ Contributions: had full access to all of the data in the study and took responsibility for the integrity of the data and the accuracy of the data analysis. Concept and design: All authors. Acquisition, analysis, or interpretation of data: All authors. Drafting of the article: All authors. Critical revision of the article for important intellectual content: All authors. Supervision. Ethical Approval: The authors have received and archived patient consent for video recording/publication in advance of video recording of the procedure. No competing financial interests exist. Runtime of video: 7 mins 51 secs.