{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T10:52:10Z","timestamp":1789555930677,"version":"build-2803163510"},"reference-count":57,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2024,4,28]],"date-time":"2024-04-28T00:00:00Z","timestamp":1714262400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Median arcuate ligament syndrome (MALS) is an uncommon condition characterized by the compression of the celiac trunk by the median arcuate ligament. Due to the anatomical proximity to the foregut, MALS has significant implications in hepato-pancreato-biliary (HPB) surgery. It can pose complications in pancreatoduodenectomy and orthotopic liver transplantation, where the collateral arterial supply from the superior mesenteric artery is often disrupted. The estimated prevalence of MALS in HPB surgery is approximately 10%. Overall, there is consensus for a cautious approach to MALS when embarking on complex foregut surgery, with a low threshold for intraoperative median arcuate ligament release or hepatic artery reconstruction. The role of endovascular intervention in the management of MALS prior to HPB surgery continues to evolve, but more evidence is required to establish its efficacy. Recognizing the existing literature gap concerning optimal management in this population, we describe our tertiary center experience as a clinical algorithm to facilitate decision-making. Research question: What is the significance and management of median arcuate ligament syndrome in patients undergoing hepato-pancreato-biliary surgery?<\/jats:p>","DOI":"10.3390\/jcm13092598","type":"journal-article","created":{"date-parts":[[2024,4,29]],"date-time":"2024-04-29T08:49:24Z","timestamp":1714380564000},"page":"2598","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Median Arcuate Ligament Syndrome (MALS) in Hepato-Pancreato-Biliary Surgery: A Narrative Review and Proposed Management Algorithm"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7237-105X","authenticated-orcid":false,"given":"Lawrence Y.","family":"Lu","sequence":"first","affiliation":[{"name":"Critical Care Research Group, The Prince Charles Hospital, Chermside, QLD 4032, Australia"},{"name":"Faculty of Medicine, University of Queensland, Herston, QLD 4006, Australia"},{"name":"Department of General Surgery, Princess Alexandra Hospital, Woolloongabba, QLD 4120, Australia"},{"name":"Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2050, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1790-6699","authenticated-orcid":false,"given":"Jacques G.","family":"Eastment","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Queensland, Herston, QLD 4006, Australia"},{"name":"Department of General Surgery, Princess Alexandra Hospital, Woolloongabba, QLD 4120, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yogeesan","family":"Sivakumaran","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Queensland, Herston, QLD 4006, Australia"},{"name":"Department of Vascular Surgery, Princess Alexandra Hospital, Woolloongabba, QLD 4120, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,4,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"731","DOI":"10.2214\/ajr.95.3.731","article-title":"Compression of the celiac trunk and abdominal angina: Preliminary report of 15 cases","volume":"95","author":"Dunbar","year":"1965","journal-title":"Am. 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