Median arcuate ligament syndrome: surgical approaches to a rarely diagnosed and undertreated disease.

In the paper “Factors associated with successful median arcuate ligament release in an international, multi-institutional cohort,”1 DeCarlo et al answer a question that only a vascular surgeon can answer: “Is one surgical approach superior to release compression on the celiac artery?” Their findings show no difference in the long-term failure rate after open release compared with laparoscopic release. At face value, this may seem to be a simple conclusion; however, it is an important advance in the treatment of median arcuate ligament syndrome (MALS).