Median Arcuate Ligament Syndrome: A Disease of Mind, Body, or Both?

Background Median arcuate ligament syndrome (MALS) is a rare condition resulting from an anatomical variation in the placement of the median arcuate ligament, which compresses the celiac artery. The difficulty in diagnosing this condition may result in chronic underdiagnosis and associated psychological distress in patients. Methods This is a single-center retrospective review of five patients diagnosed with MALS who underwent laparoscopic celiac artery decompression performed by a single senior consultant surgeon between April 2020 and April 2025. Institutional Ethics Committee approval (CSP-III/25/OCT/27/405) and consent were obtained from all participants. The primary outcome measure of the study was to evaluate subjective improvement along with gastrointestinal and vascular parameters following successful laparoscopic decompression of the celiac artery. Preoperative psychological assessment was not performed, and scores were obtained using a recall-based method. The Gastrointestinal Quality of Life Index (GIQLI) and the Kessler Psychological Distress Scale (K10) were used to assess gastrointestinal symptoms and psychological condition of the patients pre- and postoperatively, and were compared for each patient. Results All patients demonstrated significant improvement in gastrointestinal symptoms (p=0.043) and normalization of vascular parameters following laparoscopic decompression of the celiac artery. Psychological scores improved (p=0.042); however, complete subjective improvement was not observed in all patients, as postoperative evaluation revealed findings suggestive of generalized anxiety disorder in all patients, with two patients reporting depression. Conclusion In this study, laparoscopic decompression of the celiac artery did not result in complete subjective improvement, despite successful anatomical correction. Despite the small sample size, these findings emphasize the need for a standardized criterion and scoring system to guide surgical decision-making in MALS, given its complex, multifactorial nature.