Re: Management of Median Arcuate Ligament Syndrome: A New Paradigm

In a recent article in the Annals of Vascular Surgery, Duffy et al.¹ reviewed the management of and the clinical success of minimal invasive surgery in median arcuate ligament (MAL) syndrome. The existence of the MAL syndrome, also known as the celiac artery compression syndrome (CACS), was open for debate because many reasoned that an isolated respiration-dependent celiac artery stenosis could not result in symptoms. Duffy et al. clearly describe in their review article the clinical presentation, the work-up, and treatment (minimal invasive) for CACS. They reviewed the results of laparoscopy for the treatment of CACS from several case reports. To complete their review, we would like to highlight the three larger studies^2,3,4 that describe the laparoscopic and endoscopic release in CACS, published several months before the publication of Duffy et al. We realize that the article by Duffy et al. was probably accepted for publication just before the publication of these large trials.