Facing surgery can feel like stepping into the unknown, and when that surgery is for something as rare and complex as median arcuate ligament syndrome (MALS), it can be especially unsettling. MALS surgery involves relieving pressure on the celiac artery, a delicate vascular structure deep in the abdomen, and studies show that most patients experience significant relief of MALS symptoms, such as abdominal pain, nausea, and weight loss, following the procedure. 

Whether you're preparing for MALS treatment yourself or helping someone you care about, understanding each phase of the procedure and recovery can bring clarity and calm into the process. 

Read on to get answers to the most frequently asked questions about MALS surgery, and learn what to expect at every step from the best MALS surgeon in Los Angeles. 

What Does the MALS Procedure Involve? 

In people with MALS, the median arcuate ligament presses too tightly on the celiac artery, reducing blood flow to the stomach, liver, and other digestive organs. This can cause chronic abdominal pain, nausea after eating, vomiting, and unintended weight loss. To fix this, surgeons release or remove the ligament, allowing the artery to function normally again. 

The surgery can be performed in various ways, including traditional open surgery, minimally invasive laparoscopic surgery, or with the aid of advanced robotic-assisted techniques, depending on the patient’s needs. For many, the results are life-changing. Patients often notice a reduction in abdominal pain, better digestion, and an overall improvement in daily comfort and quality of life.

How Do You Prepare for MALS Surgery?

After receiving a confirmed MALS diagnosis, your surgeon will likely order imaging tests, such as a CT angiogram or Doppler ultrasound, to determine the degree of compression on the celiac artery. You may also need some lab work and an EKG to determine if you’re healthy enough for surgery. These tests, along with a pre-surgery appointment with your primary care physician, can significantly reduce risks during surgery and your likelihood of experiencing complications afterward. 

In the days leading up to the procedure, your care team may recommend pre-surgery preparation steps, such as making small dietary changes, temporarily stopping certain medications, and arranging for a friend or family member to assist with recovery once you’re home. 

What to Expect During MALS Surgery

During a MALS procedure, you’ll be placed under general anesthesia so you’re fully asleep and comfortable throughout the surgery. Depending on the approach, the surgeon may make one larger incision for open surgery or several small incisions for minimally invasive laparoscopic or robotic-assisted techniques. 

Once inside, the surgeon carefully locates and divides the median arcuate ligament, the tight band of tissue that has been pressing on the celiac artery and restricting blood flow. This delicate step is what relieves the compression and allows blood to flow more freely to your digestive organs. On average, the surgery takes about two to four hours, though the exact time depends on your unique anatomy and the surgical method chosen.

What Is Recovery After MALS Surgery Like? 

Recovery after MALS surgery is a gradual process, but most patients begin noticing improvements in symptoms like abdominal pain, nausea, and fatigue fairly quickly. Typically, you can expect to stay in the hospital for about three days, during which your care team will focus on pain management, nutrition, and ensuring your body heals properly before you return home. 

Once discharged, light activities like walking are usually encouraged within a few weeks, but it may take several months before you feel fully recovered and ready for more demanding routines. 

Beyond any urgent concerns, regular follow-up visits are scheduled to track your healing progress and discuss whether your symptoms are improving as expected. In some cases, your care team may also recommend supportive services like nutrition counseling, pain management strategies, or physical therapy to help you regain strength and feel your best. 

Complications After MALS Surgery: When to Contact a Doctor

Knowing when to contact your doctor after MALS surgery is an important part of staying safe during recovery. You should reach out right away if you notice warning signs such as: 

  • A persistent fever
  • Severe abdominal pain
  • Unusual swelling
  • New or worsening difficulty eating 
  • Difficulty breathing 
  • Weight loss

Finding the Best MALS Doctor in Los Angeles 

Choosing the right surgeon for a complex condition like MALS makes all the difference in both safety and results, and that’s why so many patients trust Dr. Danny Shouhed with their care. Dr. Shouhed’s background is rooted in both innovation and compassion, and his training at Cedars-Sinai and Mount Sinai, combined with years of experience in advanced GI and bariatric procedures, ensures every step of your surgery is carefully planned and executed.

At our practice, we combine expertise in robotic, minimally invasive, and foregut surgery to deliver highly precise treatments with reduced risk and faster recovery. We understand that MALS affects not just your digestive system but your overall quality of life, and our mission is to restore health through techniques that improve outcomes and support long-term well-being. 

Ready to get lasting relief from MALS symptoms from the best MALS surgeon in Los Angeles?