Surgical Endoscopy

, Volume 23, Issue 5, pp 1121–1124 | Cite as

Seconds from disaster: lessons learned from laparoscopic release of the median arcuate ligament

  • Kevin P. Riess
  • Luke Serck
  • Sigurd B. GundersenIII
  • Michael Sergi
  • Shanu N. KothariEmail author


Median arcuate ligament syndrome (MALS) is a rare entity that manifests as abdominal pain, nausea, vomiting, and diarrhea. The median arcuate ligament is a fibrous band that connects the crura of the diaphragm. In some people, the ligament is positioned in a way that compresses the celiac axis, which in a subset of individuals causes the symptoms associated with MALS. Surgical release of the ligament can relieve these symptoms. After viewing a video that described the laparoscopic median arcuate ligament release technique at the 2006 SAGES meeting and reviewing the online video, we report our experience with two cases and discuss the lessons learned in performing the procedure within a training program. We also discuss the extent to which surgical resident participation contributes to intraoperative complications during a new and complex surgery.


Median arcuate ligament syndrome Celiac artery compression syndrome Laparoscopic arcuate ligament release 


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The authors gratefully acknowledge the financial support provided by Gundersen Lutheran Medical Foundation.

Supplementary material

Supplementary material 1 (MPG 150778 kb)


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Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Kevin P. Riess
    • 1
  • Luke Serck
    • 1
    • 4
  • Sigurd B. GundersenIII
    • 2
  • Michael Sergi
    • 3
  • Shanu N. Kothari
    • 2
    Email author
  1. 1.Surgery ResidencyGundersen Lutheran Medical FoundationLa CrosseUSA 
  2. 2.Department of SurgeryGundersen Lutheran Health SystemLa CrosseUSA 
  3. 3.Department of Internal MedicineAurora Health CenterFond du LacUSA 
  4. 4.Yankton Medical ClinicYanktonUSA

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