Outcomes of surgical versus conservative treatment in pediatric median arcuate ligament syndrome

Objectives Median arcuate ligament syndrome (MALS) involves compression of the celiac artery and presents with gastrointestinal symptoms. We evaluated outcomes after surgical versus conservative management in pediatric MALS. Methods We reviewed charts of symptomatic patients aged 7–21 years diagnosed by ultrasound and/or computed tomography angiogram. Outcomes were categorized as resolved, improved, unchanged, or worsened at most recent follow‐up and compared between conservative and surgical treatment groups. Results Among 34 patients (median age 15 years, 79% female, 94% Caucasian), common symptoms included abdominal pain (85%) and nausea (71%); 36% had psychiatric disorders, 56% met criteria for disorders of gut–brain interaction (DGBI). Ten received conservative therapy (100% pharmacologic, 80% behavioral, 30% botulinum toxin, 20% neurostimulation) with a median follow‐up of 5 months. Outcomes were resolution (20%), improvement (40%), unchanged (40%), and none worsened. Of 24 surgical patients (median hospital stays: 4 days), outcomes were: resolution (21%), improved (33%), unchanged (17%), worsened (29%); not significantly different from conservative group ( p = 0.21). Postoperative complications occurred in 21%. At median 20‐day postoperative follow‐up, 52% reported resolution, 35% improved, 9% unchanged, 4% worsened. Pain location differed by group ( p = 0.005); other demographics and long‐term outcomes did not ( p > 0.05). Baseline comorbidities and treatment modalities were not significantly associated with outcome ( p > 0.05). Conclusion In our cohort, 60% of children with MALS improved with conservative DGBI‐directed therapy and 54% improved with decompression surgery at long‐term follow‐up, despite a robust short‐term postoperative response (87%). Prospective studies are needed to guide patient selection and assess long‐term outcomes.