MALS can sometimes be treated with surgical intervention. There are three primary surgical techniques: robotic-assisted, laparoscopic, and open. However, because MALS is a young diagnosis without much research, surgical procedures vary between surgeons.
A robotic-assisted surgery is a laparoscopic procedure that gives surgeons more control, precision, and flexibility. Unfortunately, there is little literature on MALS-specific procedures, but this approach is used by some surgeons and is very similar to a conventional laparoscopic surgery.
To treat MALS laparoscopically, small incisions are made to allow surgical instruments access to the median arcuate ligament. The ligament is released and trimmed to relieve compression on the celiac artery. In some cases, part of the celiac ganglion may be removed. However, it is impossible for the surgeon to remove the full ganglion, as they cannot fully visualize it with a laparoscopic surgery. Laparoscopic surgeries offer the typical benefits of any minimally invasive surgery: quicker recovery time, a shorter hospital stay, and an early return to diet. Rarely, there is the potential that a laparoscopic approach may need to be converted to an open procedure if the aorta or celiac artery are nicked.
The third and final surgical technique used to treat MALS is an open approach. An incision is made down the patient’s abdomen, allowing the surgeon complete access and visualization of the abdominal cavity. The surgeon releases and trims the median arcuate ligament, relieving the compression on the celiac artery. In this approach, the celiac ganglion can be trimmed or completely removed. Because this is a more invasive surgery, both the recovery time and hospital stay are longer, but most patients are able to resume eating the day after surgery.
The type of surgery a patient undergoes is a personal choice, and one that should be highly researched. Research is still necessary once a patient has decided on robotic-assisted, laparoscopic, or open surgery, because full procedures differ between surgeons. It is also wise to ask for a surgeon’s numbers–how many MALS surgeries he or she has performed, along with their success ratio–as there are some who have done one, and some who have done over one-hundred. Because of all this, it is important for patients and caretakers to research all of their options before deciding on a specific treatment plan.