Median Arcuate Ligament Syndrome (MALS)

I did not find the surgery to be scary. Mine was in 2015 and laproscopic. Basically all I remember about that day is being on a gurney at 5 a.m. and having the surgeon greet me. When I woke up, the rest of that day was a fog of IV pain medication. I remember trying to watch football and having no idea what was going on. The 2nd day they switched me to oral pain meds and I was allowed to get up and walk around, but because I developed a slight fever they kept me another night. After that I was home and back to work the next week.

Only bummer is I'm looking at a 2nd surgery now because the first surgeon didn't do enough, or remove the celiac ganglion. I had a milder version of the first round (pain/nausea in the mornings and when I work out). Hopefully they can take care of yours adequately the first time.

Hi!
Has anyone experienced decreased motility after Mals surgery?
I had my surgery almost two years ago and it was Thank G-D very successful, I no longer have that pain after eating and all the other symptoms.

I am still really struggling with motility thought and it surprisingly got worse after my surgery. Has anyone experienced this? If so what do you do about it?
I’ve been on just about every medication for it and the only thing that has worked is Linzess in a very high dosage, but is now stopping to work. My doctor is recommending that I now try Motegrity, have any of you taken this? What is your experience with it?
Thank you in advance

@chicken - I have had motility problems for years before surgery. I did not notice an increase. I have SIBO too - goes along with decreased motility. I tried Linzess, but it did not work for me. All I do is rotate laxatives, not taking daily though. I forgot how it is to be normal!

I had MALS open surgery a year ago. I have had problems with chronic constipation. My GI said “just live with it” and my MALS surgeon said “ it could put me back in the hospital”. I tried Miralax (2x daily), sennacot, fiber gummies, magnesium, Linzess, benefiber and had no relief. I saw someone was using a prescription called lactulose. It’s a syrup and since I have been using it, I have been normal which is a miracle. I still have tightening around my lower ribs and can’t eat certain foods like tomatoes, onions, garlic. My MALS doctor rechecked a new ct scan and everything looks good so I went to a pain doctor. He did an radio frequency ablation on the splenic nerves bc my MALS doctor thinks I have scarring and inflammation still. Hopefully that works.

I've dealt with SIBO as well. It predated MALS and was most likely caused by a GI doc putting me on prilosec permanently. Before that I could eat anything. SIBO-C can be treated with 4 weeks of herbs and a strict diet, but it can also come back. I've found Naturopathic doctors far more helpful with SIBO treatment.

I have an appointment for a celiac plexus block next week. It's a diagnostic block, I think. This is to confirm that my pain/nausea recurrence really is MALS and whether a 2nd surgery will benefit me. I'm actually kind of looking forward to this. I've never had a nerve block before, and the idea of not having any pain for a few days is exciting.

Hi @tonlop628

Welcome to the group. @lasirvent has mentioned the longer it goes on the worse it gets. I can vouch for this as my operation was cancelled here in the UK last April. I was already at a chronic stage with only a few foods that didn't send the pain into the stratosphere. Nearly a year on and there are no foods I can eat, I am losing 2kg a month which provides another challenge; keeping my BMI above the minimum for surgery.

Try not to stress about the surgery, in my eyes it is a far better alternative to worsening pain. Keep us updated.

Mark

Hi @chicken

Again, I have to agree with @lasirvent, Lactulose is a great way to increase intestinal motility. I was given it many years ago after a laparotomy which basically caused my intestines to shut down completely. It took a while to get going again but the Lactulose worked.

I stopped using Lactulose in favour of a more natural remedy, so I started eating liquorice daily. I didn't eat too much and it is important to let you know that eating a lot of liquorice daily can reduce your potassium levels which in turn can cause high blood pressure. It is always best to discuss with your primary practitioner as a lot of liquorice can interact with certain meds like warfarin.

However, the benefits of eating liquorice for digestive problems and other conditions can be great, it is thought to have antimicrobial, anti-inflammatory and antiviral properties too. Just make sure that if you buy liquorice sweets, they actually contain liquorice plant extract, as many sweet sold as liquorice don't have any liquorice in them at all. You can get deglycyrrhizinated liquorice as over the counter supplements, this stops the possibility of those side effects as the cause, (glycyrrhizic acid) is extracted. But I'm a liquorice sweet fan and enjoy the yummy taste of the sweets! Look up the benefits of deglycyrrhizinated liquorice if you are wanting an over the counter remedy.

Mark

Hello. I've been on here before and was diagnosed with MALS and had laparoscopic that was converted to open in 2019. I was pain-free for a year and now started having the old symptoms return. Pain after eating, bloating, and nausea. So I decided to go back to my primary and he sent me to get a Doppler US which was difficult in seeing my celiac artery because of a large gas bubble. However, she did get my velocity clocked in at 261 which the doctor said that my the celiac artery was probable 70% blocked. So now I went to my surgeon Dr. Lowery on what I should do since I was still having pain. He said that it's possible that the artery could have closed up after surgery, or the scar tissue has built up and is causing the artery issues. So now I'm waiting to see a vascular surgeon to see what the next step is. Moreover, Dr. Lowery said the worst-case scenario would be opening me back up again and removing the scar tissue. Which he said it could be a very long surgery and a very risky one. So, has anyone, had the experience of this reoccur and what was the outcome? Thanks

@jayson - It is very upsetting to get the symptoms back. I did after 6 months. They did another angio CT and saw that the artery had not opened up after the pressure from the ligament was removed.
The plan was to try placing a stent- I was warned that if that failed they would have to open up and repair artery.
Do you have confidence in your surgeon?

The original surgeon I feel was very good. He took the time to listen to me and was very understanding. He was the only one who believed me unlike others I dealt with. My first vascular surgeon laughed at me and said that your celiac artery wasn't the problem. That it was all just in my head. It wasn't until Dr. Lowery sent me out for another Doppler US. My velocities were from 580 to 620. After that, the original vascular surgeon sent a certified letter stating my health was in danger and I needed to see him ASAP. LOL! So I'm very reluctant to see this new vascular surgeon her name is Jenny Cho. She's out of KU MED CENTER IN KS. So I have an appointment on April 8th and we will see what she wants to do. I feel she will just blow me off as the other did. It sad people go to their doctors and they just look at you as nothing is wrong. It's their arrogance that comes through when they don't know about MALS. However, I believe I found a good general surgeon who listens and is willing to do what is right for me.