Robotic Median Arcuate Ligament Release

Median arcuate ligament syndrome (MALS) results from the compression of celiac trunk by an anatomically abnormally median ligament. Symptoms nausea, vomiting, and epigastric pain are attributed to ischemia foregut stemming compression. Due presentation variability rare prevalence, MALS is often a diagnosis exclusion. The can be unclear, as such, large, open, invasive surgery for such problem not idea. We present case patient with atypical symptoms found have underwent minimally robotic surgical treatment. A 43-year-old woman presented 3 months severe initially associated eating then progressing. Initial GI workup was inconclusive, but computed tomograph scan abdomen pelvis demonstrated narrowing artery origin patent distal celiac, superior mesenteric artery, inferior artery. Mesenteric duplex ultrasonography indicated elevated velocities consistent >50% stenosis worse expiration. She block which improved her roughly 50%, returned. Patient elected proceed release (RMALR) plexus neurolysis. discharged on postoperative day 1. had complete resolution 2.5 weeks one month postoperatively, confirmed repeat demonstrating stenosis. MALS, poorly understood presenting mostly in younger women, nonspecific lack diagnostic criteria, typically determined ruling out other causes symptoms, imaging studies or ultrasound examination. Treatment options include intervention, laparoscopic open approach used more than RMALR, despite advantages visualizations, control, maneuverability, reduced operation time. Additionally, RMALR has been higher rates symptom relief, lower recurrence complications. remains safe effective management patients symptomatic MALS.