How is median arcuate ligament syndrome treated?

Once the diagnosis of MALS is confirmed, most patients will be offered a minimally invasive (laparoscopic/robotic) approach to relieving the compression of the median arcuate ligament on the aorta. In this technique, the surgeon makes five to six small (approximately 1/2 inch) incisions (cuts) and inserts instruments to separate the median arcuate ligament and divide the nerves (neurolysis).

Most patients who have laparoscopic surgery for MALS stay overnight in the hospital and begin eating a normal diet the next morning. Patients will have some discomfort and pain from the incisions, and will receive medications to relieve the pain. Most patients say that their MALS symptoms, such as pain with eating, improve after the surgery. Most patients are able to return to normal activities within two to four weeks.

About 10% of patients have a traditional “open” operation, in which a large incision is made down the middle of the abdomen, often with the assistance of one of the vascular surgeons. Patients who have this procedure may need to stay in the hospital for three to five days for recovery, and can usually return to normal activities within four to six weeks.

What is a celiac plexus block?

A celiac plexus block is an injection of medication to help relieve pain in the abdomen.

Median arcuate ligament release Median arcuate ligament release

If you have a celiac plexus block, you will be given an intravenous medication to relax you. Then you will lie on your stomach on an x-ray table. The doctor will numb an area of skin on your back with a local anesthetic. Then, guided by an x-ray, the doctor will:

  • Insert a thin needle into your back, next to your spine, and inject an anesthetic.
  • Insert a second needle on the other side of your spine.
  • Inject dye to make sure the medication goes to the correct spot.
  • Inject pain medication, such as epinephrine, clonidine, or a steroid. Alcohol or phenol also may be injected to destroy the nerves.

The procedure usually takes less than 30 minutes, and you can go home the same day. Your abdomen may feel warm, and you may begin to feel less abdominal pain.

Patients usually need a series of injections (between two and 10) to continue the pain relief. For some people, a celiac plexus block can relieve pain for weeks. For others, the relief can last years. Many can return to their normal activities.

Last reviewed by a Cleveland Clinic medical professional on 09/27/2017.

References

  • El-Hayek KM, Titus J, Bui A, Mastracci T, Kroh M. Laparoscopic median arcuate ligament release: are we improving symptoms? J Am Coll Surg 2013 Feb;216(2):272-9. doi: 10.1016/j.jamcollsurg.2012.10.004. Epub 2012 Nov 21.
  • Weber JM, Boules M, Fong K, Abraham B, Bena J, El-Hayek K, Kroh M, Park WM. Median Arcuate Ligament Syndrome Is Not a Vascular Disease. Ann Vasc Surg 2016 Jan;30:22-7. doi: 10.1016/j.avsg.2015.07.013. Epub 2015 Sep 10.
  • Genetic and Rare Diseases Information Center. Celiac artery compression syndrome Accessed 9/28/2017.
  • Jimenez JC, Harlander-Locke M, Dutson EP. Open and laparoscopic treatment of median arcuate ligament syndrome. J Vasc Surg. 2012 Sep;56(3):869-73.

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