MALS and ligament release surgery: video explainer
A short captioned video, about a minute and a half, with no sound. It shows how a low median arcuate ligament squeezes the celiac artery, why the squeeze is tighter when breathing out, and how release surgery is done, step by step.
Chapters
- Normal anatomy
- MALS: breathing in
- MALS: breathing out
- After ligament release surgery
- Surgery: Reaching the ligament
- Surgery: Dividing the ligament
- Surgery: Removing nerve tissue
- Surgery: Checking the artery
Full transcript
- 0:03 The median arcuate ligament joins the two sides of the diaphragm in front of the aorta.
- 0:09 It usually passes above the start of the celiac artery.
- 0:14 In MALS the ligament sits low and presses the celiac artery into a hooked narrowing.
- 0:19 When breathing in, the squeeze is usually smaller.
- 0:23 When breathing out, the squeeze becomes tighter and blood speeds up.
- 0:27 Many centers use a duplex ultrasound peak speed above 200 cm/s as one sign.
- 0:33 Surgery divides the ligament so it no longer presses on the artery.
- 0:38 In one study the breathing-out flow speed fell from about 348 to 251 cm/s.
- 0:47 The operation can be open, laparoscopic (small cuts and a camera) or robotic.
- 0:52 Minimally invasive methods are generally favored for faster recovery.
- 0:56 The surgeon divides the ligament fibers over the celiac artery, layer by layer,
- 1:01 until the artery is no longer pinched.
- 1:04 The nerve tissue around the artery (celiac plexus) is often removed too.
- 1:09 In one series of 100 operations, this was done in 95.
- 1:13 Duplex ultrasound during surgery can check the artery.
- 1:16 Flow speed back to normal, with no change on breathing, confirms the release.
About this video
- The drawings are schematic and not to scale. Each step is based on published research; the sources are listed with the same steps in our MALS guide.
- Numbers in the video come from single studies and are examples, not predictions for one person.
- This video is educational only and is not medical advice. Talk with your doctor about your own situation.
See also: MALS surgery results from every published study and US hospitals that publish on MALS.
MALS Compass is an independent educational website, not a medical provider, and is not affiliated with any hospital, clinic or university. This page is educational information and does not replace advice from your own doctor. For any question about your health, please contact your doctor or an official healthcare institution.
