How is the decision made that surgery is needed?
Patients who think they may have MALS are scheduled for a screening mesenteric ultrasound. This ultrasound can measure the blood flow through the celiac artery and confirm whether the blood vessel is being compressed. If the ultrasound is positive, we will arrange a CT angiogram that will produce a 3D image of the celiac artery and confirm the findings. In addition, we will ask your primary care physician or gastroenterologist to obtain a complete diagnostic evaluation before moving forward with MALS surgery.
The complete medical diagnostic workup includes the following:
Colonoscopy with biopsies
Upper endoscopy with biopsies
Testing for Celiac Disease
Testing for H Pylori
Upper GI barium swallow
Ultrasound of the gallbladder
HIDA scan of the gallbladder
Ultrasound of the reproductive organs (females only)
Additionally, as part of our comprehensive preoperative MALS evaluation, you will need to complete a pre-surgical psychological evaluation. There is a significant relationship between physical illness/disease, pain, stress and mental health. Specifically, abdominal pain serves as an additional stressor for families in a way that challenges well-being and daily functioning. Therefore, the purpose of this psychological evaluation is to identify any mental health comorbidities, any significant psychosocial stressors that may be associated with abdominal pain and/or any other mental health symptomatology that could be impacting current functioning or could affect post-surgical outcomes. The psychological evaluation includes the following:
Self-report questionaires
Psychosocial interview
The final required component of your preoperative MALS evaluation is an assessment by the Pain Service.
At the completion of all your required evaluations, the MALS team will provide recommendations to you. It is likely that you will need to complete these multi-disciplinary recommendations prior to arranging a surgery date in order to ensure an increased likelihood of success after surgery.
What can I expect from surgery?
The surgery will be done utilizing laparoscopic technique. 5-6 laparoscopic incisions will be made in the abdomen. The median arcuate ligament will be released and we will obtain a repeat duplex ultrasound in the operating room to confirm that the blood flow has normalized. Once the surgeon is satisfied that the blood flow has been normalized, the surgery is complete.
When will I be able to go home?
Patients will be admitted to the hospital after surgery. The average stay in the hospital is approximately 4 days. Once the patient is tolerating a regular diet, pain is well controlled with oral pain medications and they are able to walk without assistance, they will be discharged home.
What care is needed at home after surgery?
Care of the incisions: The laparoscopic sites will have a shiny substance over them called Dermabond. Although we will allow bathing within a few days after surgery, the Dermabond over the incisions SHOULD NOT be scrubbed off or removed. The Dermabond will disappear on its own. This may take several weeks.
Activity: The patient should not do any heavy lifting, strenuous activity or sports until they are cleared by the surgeon.
Diet: The patient may have a regular diet; however, it is recommended that they eat several small meals, rather than a few large meals. Constipation is common after surgery. Anesthesia and pain medication can contribute to constipation. The patient should take plenty of water and avoid beverages with caffeine or alcohol in them.
Medication: It is important to take the pain medications as directed by the surgeon. If the pain is not under control, the surgeon or his representatives should be contacted.
When should I call the surgery team?
Call if there are any questions or if there is bleeding or drainage from the incision sites, fever over 101F, vomiting or a decrease in urinary output.
Patients who think they may have MALS are scheduled for a screening mesenteric ultrasound. This ultrasound can measure the blood flow through the celiac artery and confirm whether the blood vessel is being compressed. If the ultrasound is positive, we will arrange a CT angiogram that will produce a 3D image of the celiac artery and confirm the findings. In addition, we will ask your primary care physician or gastroenterologist to obtain a complete diagnostic evaluation before moving forward with MALS surgery.
The complete medical diagnostic workup includes the following:
Colonoscopy with biopsies
Upper endoscopy with biopsies
Testing for Celiac Disease
Testing for H Pylori
Upper GI barium swallow
Ultrasound of the gallbladder
HIDA scan of the gallbladder
Ultrasound of the reproductive organs (females only)
Additionally, as part of our comprehensive preoperative MALS evaluation, you will need to complete a pre-surgical psychological evaluation. There is a significant relationship between physical illness/disease, pain, stress and mental health. Specifically, abdominal pain serves as an additional stressor for families in a way that challenges well-being and daily functioning. Therefore, the purpose of this psychological evaluation is to identify any mental health comorbidities, any significant psychosocial stressors that may be associated with abdominal pain and/or any other mental health symptomatology that could be impacting current functioning or could affect post-surgical outcomes. The psychological evaluation includes the following:
Self-report questionaires
Psychosocial interview
The final required component of your preoperative MALS evaluation is an assessment by the Pain Service.
At the completion of all your required evaluations, the MALS team will provide recommendations to you. It is likely that you will need to complete these multi-disciplinary recommendations prior to arranging a surgery date in order to ensure an increased likelihood of success after surgery.
What can I expect from surgery?
The surgery will be done utilizing laparoscopic technique. 5-6 laparoscopic incisions will be made in the abdomen. The median arcuate ligament will be released and we will obtain a repeat duplex ultrasound in the operating room to confirm that the blood flow has normalized. Once the surgeon is satisfied that the blood flow has been normalized, the surgery is complete.
When will I be able to go home?
Patients will be admitted to the hospital after surgery. The average stay in the hospital is approximately 4 days. Once the patient is tolerating a regular diet, pain is well controlled with oral pain medications and they are able to walk without assistance, they will be discharged home.
What care is needed at home after surgery?
Care of the incisions: The laparoscopic sites will have a shiny substance over them called Dermabond. Although we will allow bathing within a few days after surgery, the Dermabond over the incisions SHOULD NOT be scrubbed off or removed. The Dermabond will disappear on its own. This may take several weeks.
Activity: The patient should not do any heavy lifting, strenuous activity or sports until they are cleared by the surgeon.
Diet: The patient may have a regular diet; however, it is recommended that they eat several small meals, rather than a few large meals. Constipation is common after surgery. Anesthesia and pain medication can contribute to constipation. The patient should take plenty of water and avoid beverages with caffeine or alcohol in them.
Medication: It is important to take the pain medications as directed by the surgeon. If the pain is not under control, the surgeon or his representatives should be contacted.
When should I call the surgery team?
Call if there are any questions or if there is bleeding or drainage from the incision sites, fever over 101F, vomiting or a decrease in urinary output.