Any chronic illness diagnosis is hard to hear, and a MALS diagnosis is no exception. If you’ve been recently diagnosed with this complicated condition, there is hope…and help.

MALS (Median Arcuate Ligament Syndrome) is a rare, yet chronic, condition you probably never heard of that affects both children and adults, but for unknown reasons, is prevalent in women. It’s the cause of chronic abdominal pain, especially following meals, when the arc-shaped band of tissue in the chest region, or median arcuate ligament, presses against the celiac artery that supplies blood to the organs in the upper abdomen. In most people, the ligament tends to run across the largest blood vessel in the body (aorta), sitting directly above the celiac artery without causing pressure, pain, or other issues. It’s when the ligament is obscurely situated that causes unbelievable amounts of pain.

MALS Symptoms

MALS symptoms can significantly impact quality of life for its sufferers to the point of severe weight loss and possibly triggering fear of eating or sitophobia. Other problematic symptoms include:

  • Long-term, chronic pain in the upper or middle abdominal region, especially after eating or exercising
  • Malnutrition
  • Bloating
  • Vomiting/nausea
  • Weight Loss
  • Repeat hospitalizations

Somewhat a medical mystery in its origins, the underlying causes of MALS are still hotly debated within the medical community. However, many doctors and gastrointestinal specialists believe the rare disorder and its painful symptoms are due to the lack of optimal blood flow through the celiac artery or compression on the nerves of the celiac ganglion. Some even speculate that it could be a genetic anomaly.

Next Steps: Treatment Options To Help Manage MALS

After receiving a MALS diagnosis, you’re most likely wondering what your best options are for treating and managing a seemingly incurable, lesser-known condition. There are proven, groundbreaking interventions that can help ease symptoms, pain, fear and help vastly improve quality of life. Depending on your specific needs, medical history, and health goals, you and your doctor can discuss a viable, customized treatment trajectory perfect for you. Delaying surgery can lead to worsening problems. If you are a candidate for MALS, the best option is surgery.

Median Arcuate Ligament Release

While MALS surgeries are typically performed through traditional, open surgery, an advanced, minimally invasive procedure, known as laparoscopic surgery, is performed to alleviate the debilitating symptoms associated with MALS. Dr. Danny Shouhed, MD takes this a step further by using the da Vinci Surgical System to successfully perform this operation robotically with increased accuracy and reduced risk, allowing patients to have decreased post-operative pain and hospital length of stay. During this procedure, 4 small incisions are made through the abdomen to access the median arcuate ligament. The ligament is then surgically separated and released to relieve painful compression on the celiac artery and irritation of surrounding nerves of the celiac plexus, dividing and resecting the celiac ganglion and plexus of nerves.


There are only a few select surgeons in the United States that can perform this type of surgery. Dr. Shouhed has published multiple articles on MALS and is recognized across the country as one of the leading surgeons on the diagnosis and treatment of MALS, mentoring surgeons across the country on how to perform this operation successfully.

If you’ve been recently diagnosed with MALS and have questions regarding the next steps, treatment options, or procedures, please be sure to contact our office to speak with any one of our talented team members and set up a one-on-one consultation with board-certified Dr. Shouhed. Dr. Shouhed is a Los Angeles-based, renowned surgeon specializing in minimally invasive technologies, such as robotic bariatric, as well as gastrointestinal and general surgeries.