MALS Surgery: Before, During, and After the Procedure

Having recurring abdominal pain, nausea, and vomiting? These could be signs of Median Arcuate Ligament Syndrome (MALS). MALS occurs when the celiac artery becomes compressed due to the median arcuate ligament, reducing blood flow to abdominal organs. Although rare, MALS can be uncomfortable and distressful for those affected.

MALS surgery may relieve symptoms of celiac compression by releasing the compressed celiac artery. Any surgery can be daunting, and patients must know what to expect before, during, and post-procedure.

Exploring MALS Surgery

This post will review the steps involved with MALS surgery – pre-op preparation, the procedure itself, and post-op recovery.

Before the Procedure

  • Consultation with a Surgeon: To begin MALS surgery, the first step should be arranging a consultation with a surgeon specializing in this procedure. At this consultation, they will evaluate your symptoms and medical history before ordering imaging tests to confirm your MALS diagnosis. If they determine that you qualify as a candidate for MALS or for a celiac block injection procedure, they will discuss the potential risks and benefits of such a surgical procedure.
  • Pre-Operative Preparation: Once you decide to undergo MALS surgery, the surgeon will provide preparation instructions. This may involve fasting for an adequate time before surgery, discontinuing certain medications, and avoiding certain foods or drinks. Before proceeding, they may also suggest undertaking pre-operative testing such as blood work or an electrocardiogram.

    Another option you can discuss with your surgeon is the Celiac Ganglion Nerve Block procedure. Click here for more information about this procedure. 

During the Procedure

  • Anesthesia: MALS surgery is conducted under general anesthesia, meaning you will be asleep throughout the procedure. An anesthesiologist will be present during surgery to monitor vital signs and ensure you remain comfortable.
  • Incision: Your surgeon will make a small incision to gain access to the celiac artery, which has become compressed during MALS. This may either be vertically or horizontally, depending on their preferred placement and desired results. 
  • Ligament Release: After performing this step, your surgeon will release the median arcuate ligament, compressing your celiac artery and restricting blood flow to organs in your abdomen. To accomplish this release process, they may cut or trim away part of it before reopening it again for the proper function of the celiac artery and improved blood flow to the internal organs of the abdomen.
  • Closure: Once the ligament has been released, a surgeon will close the incision using either sutures or staples and place a small drain to collect any extra fluid accumulating.

After the Procedure

  • Hospital Stay: You will be carefully monitored. Any discomfort may be treated with medications for pain. To avoid issues like blood clots, you will be encouraged to stand up and move around as soon as possible.
  • After Surgery: You should take it easy and check-up with your surgeon frequently to ensure you’re recovering properly. Avoiding physical exertion or heavy lifting until told to do so may be advised. 
  • Long-Term Outlook: Most patients who undergo MALS surgery experience considerable relief in their symptoms; however, any surgery can carry risks like bleeding, infection, or organ damage that must be discussed with your surgeon before beginning any procedure.


MALS surgery can offer much-needed relief to those with median arcuate ligament syndrome. Although the procedure involves risks, many find its benefits outweigh them. If considering MALS surgery as a means of relief, consult with a surgeon specializing in it for the best advice and information before making your decision.