Median arcuate ligament syndrome, or (MALS), is a rare, complex, under-diagnosed disease that often causes chronic, debilitating pain in the upper part of the abdomen. MALS is characterized by the compression of the celiac artery as it passes through the median arcuate ligament, a band of tissue in the abdomen. This compression leads to blood flow changes, as well as nerve entrapment and inflammation, causing a range of distressing MALS syndrome symptoms, including severe abdominal pain, particularly after eating, as well as unintended weight loss due to sitophobia (fear of eating), bloating, constipation, diarrhea, nausea, and vomiting.
The hallmark of MALS is its excruciating pain, primarily concentrated in the upper abdomen, which often radiates to the back. The pain's timing, typically occurring within 15-30 minutes after meals, is a distinctive feature that sets it apart from other gastrointestinal conditions.
Once MALS disease is diagnosed, there are two main treatments that may be recommended. A celiac block injection can offer temporary relief from the painful MALS syndrome symptoms and is commonly used as part of the diagnosis process, but it does not permanently relieve pressure on the celiac plexus nerves or aorta. MALS surgery offers a long-lasting solution to relieve the symptoms of MALS.
For individuals diagnosed with MALS, there are two main treatment options. The first is a celiac nerve block, a minimally invasive procedure designed to alleviate pain. During this procedure, a local anesthetic is injected near the celiac plexus, a bundle of nerves responsible for transmitting pain signals from the abdomen. By blocking these nerves, patients can experience significant pain relief without the need for surgery.
Median arcuate ligament syndrome, or (MALS), is a rare, complex, under-diagnosed disease that often causes chronic, debilitating pain in the upper part of the abdomen. People with MALS are born with an anatomic abnormality of the their diaphragm and median arcuate ligament, causing the median arcuate ligament to compress the celiac artery, a major branch of the abdominal aorta, and the celiac nerve ganglion and plexus of nerves. This pressure can lead to blood flow changes, as well as nerve entrapment and inflammation, resulting in extreme pain, sitophobia (fear of eating), significant weight loss, constipation and diarrhea.More About MALS SURgery
It's worth noting that some patients may seek alternative treatments for MALS that don't involve surgery. These options can include dietary modifications, pain management strategies, and lifestyle adjustments aimed at minimizing symptom exacerbation. While these methods may provide some minimal relief, they do not address the root cause of MALS and are generally considered complementary to medical interventions.
Dr. Shouhed is uniquely qualified to offer patients innovative robotic surgery as a treatment option for MALS. He has published multiple peer-reviewed articles on MALS and is recognized across the country as one of the authoritative figures on the diagnosis and treatment of MALS. He is not only an expert in the diagnosis and treatment of MALS, but with the superior skill provided by Dr. Shouhed, robot-assisted MAL release can be performed safely and effectively with the avoidance of conversion events and minimal morbidity. “The robotic approach will allow for a very precise and delicate separation with release of the ligament,” says Dr. Shouhed. In this procedure, 4-5 tiny incisions are made in the abdomen to access the median arcuate ligament and view the tissues through a laparoscope.
The ligament is separated and released to relieve compression on the celiac artery of the aorta and irritation of the nerves of the celiac plexus. MALS surgery usually requires an overnight stay in the hospital for observation, but most patients can return home the next day. Symptoms like abdominal pain after eating are usually relieved immediately after MALS surgery. If you have been diagnosed with MALS and want to explore permanent treatment options, contact our office in Los Angeles. Our staff can schedule a consultation with Dr. Shouhed to discuss MALS surgery, or median arcuate ligament release.
Dr. Danny Shouhed, MD, FACS, is a renowned expert in foregut diseases, particularly those involving the upper gastrointestinal tract. He is recognized nationally for his mentorship and education in conditions like MALS (Median Arcuate Ligament Syndrome) and robotic surgery. Patients from around the world seek consultations with Dr. Shouhed due to his extensive knowledge and specialized training. He is a leading authority on the diagnosis and treatment of MALS, offering innovative robot-assisted surgery. With his precise approach, he is able to provide safe and effective procedures. Dr. Shouhed's impressive background includes medical education at UCSD, residency at Cedars Sinai, and fellowships in minimally invasive surgery, making him a top MALS surgeon in Los Angeles.
Discover the inspiring testimonials from some of our valued patients as they candidly share their experiences and achievements following their life changing surgery performed by the highly skilled and compassionate Dr. Danny Shouhed. Witness the huge impact these individuals have encountered on their weight loss journey and envision the possibility of achieving similar success for yourself through the expert guidance and care provided by Dr. Shouhed.Read More Reviews
"Dr. Shouhed from the first visit assured me that he could help me, and would help me get to the bottom of my issues. He was able to relieve my pain associated with MALS. Dr. Shouhed has been able to refer me to specialists that can address my other issues and is overseeing to the end. I cannot say enough about Dr. Shouhed and his care of his patients. He is up on everything MALS and more."