Celiac trunk stenosis by median arcuate ligament in orthotopic liver transplantation: a potential hidden foe to the biliary tree

Median Arcuate Ligament Syndrome (MALS) in Hepato-Pancreato-Biliary Surgery: A Narrative Review and Proposed Management Algorithm

“…Another single-center European study also showed no differences in short-and long-term outcomes between OLT patients with surgically treated MALS or without MALS [31]. On the contrary, a recent study reported that untreated MALS is associated with increased biliary complications and reduced graft survival highlighting the potential importance of MALS management prior to OLT [32]. Noticeably, the decision to treat MALS during OLT is arbitrary in these studies, with varied degrees of stenosis of the celiac trunk reported.…”

“…Reduced blood flow predisposes the graft to hepatic arterial thrombosis, a dreadful complication that can lead to cholangitis, poor graft function, graft loss, and death [29]. The prevalence of MALS during OLT is reported to be up to 10%, and contemporary well-powered studies on its management are scarce in the literature [30][31][32][33]. Gialamas et al demonstrated no statistically significant difference in graft survival or post-operative biliary complications between patients with and without MALS in their retrospective case-control study [30].…”