Median Arcuate Ligament Syndrome (MALS) Surgery

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Our Approach

Median Arcuate Ligament Syndrome (MALS) is an uncommon and under-diagnosed disease that often causes chronic pain in the upper part of the abdomen. 

We approach MALS from a purely neurological perspective. Our treatment strategy identifies nerve inflammation as the main cause of pain. This approach is different from the traditional belief that gastric ischemia (injury to the small intestine from insufficient blood supply) due to celiac artery stenosis causes pain in patients with MALS.

MALS was first discovered in the 1940s, and between 1963 and 2012, only 500 surgeries were performed. This means research and treatment for MALS is constantly evolving. Because of this, many surgeons have different approaches to treating MALS. That's why it's important to find a doctor experienced in MALS who can work individually with patients on specific and life-long treatment plans.

Why Choose Us

We have treated patients from 40 states, and even Canada and Australia. This is a true testament to Stamford Health's success rate with MALS treatment in both children and adults. 

Since MALS is a relatively rare disease that is often mistaken for gastritis, our team aims to extend beyond the community and support those who may be having unexplained abdominal pain and other symptoms. That's why we have created a national referral center for diagnosis and treatment of MALS at Stamford Health.

Our goal is to provide comprehensive care and lifelong relief of chronic pain in both children and adults.

MALS Symptoms, Treatment and Diagnosis

Those with MALS are born with their diaphragm too low, causing the median arcuate ligament, a ligament under the diaphragm, to compress the celiac artery, a major branch in the abdominal aorta. This pressure can cause blood flow to change and nerves to inflame and become trapped, which sends pain signals to the brain. Some describe MALS as a "pinched nerve" in the abdomen which can make digestion extremely painful and pain can even spread into the back.

Specific symptoms of MALS include:

  • Pain and/or fatigue after eating
  • Nausea/vomiting
  • Unexplained weight loss
  • Constipation/diarrhea

Usually, a CT-scan of the abdomen can detect the structure of MALS. We may also perform a physical exam or injections that help relieve abdominal pain.

At this point, the only treatment for MALS is surgery. Depending on the symptoms and factors involved, we may recommend minimally invasive MALS surgery or open MALS surgery. Each approach aims to reduce or eliminate pain and help those who are truly suffering regain their quality of life.