Single-surgeon series reports pain relief after minimally invasive surgery for median arcuate ligament syndrome

A retrospective study in Surgical Endoscopy assessed 100 consecutive patients undergoing minimally invasive surgery for median arcuate ligament syndrome (MALS) by one surgeon between November 2016 and October 2024. Diagnosis incorporated clinical symptoms and imaging or response to a celiac nerve ganglion block. Patients undergoing revision after another surgeon’s primary procedure were excluded. All underwent celiac artery decompression and median arcuate ligament release; 95 also underwent celiac ganglion nerve plexus resection. Mean age was 29 years.

The results reported chronic abdominal pain relief in 94.9%, with five patients experiencing no improvement, although the conclusion cited 94 patients with symptomatic relief. Among 47 patients with food-related epigastric pain, weight loss exceeding 10 pounds, and relief after a preoperative nerve block, 95.7% achieved at least 50% postoperative pain-score improvement. Mean operative time was 126 minutes and hospital stay averaged 2.8 days. Three intraoperative complications included one conversion to open surgery; one postoperative complication required reoperation for chylous ascites.

Follow-up averaged 10.7 months but ranged from two weeks to 5.8 years. The findings suggest favorable outcomes in selected patients, but the retrospective, uncontrolled, single-surgeon design and variable follow-up limit generalizability and assessment of durable benefit. The discrepancy in overall response reporting requires clarification. Authors reported no financial disclosures or conflicts of interest.