Celiac Ganglia
This procedure consists of surgically removing part of the — clusters of nerves located around the celiac artery and aorta in the upper abdomen.
In MALS:
- The median arcuate ligament compresses the artery
- Chronic compression can inflame and overstimulate nearby nerves
- Those nerves may continue producing pain signals even after blood flow improves
An open ganglionectomy attempts to address the neurologic pain component directly.
What happens during surgery?
Through a larger abdominal incision, the surgeon:
- Opens the upper abdomen
- Exposes the aorta and celiac artery
- Completely divides the median arcuate ligament
- Removes scar tissue and fibrotic tissue
- Performs extensive celiac plexus neurolysis
- Removes portions of the celiac ganglia
The surgeon may also:
- Skeletonize the artery (fully clean tissue off it)
- Assess blood flow immediately
- Repair or reconstruct the artery if damaged from chronic compression
Why Open vs. Laparoscopic?
Open surgery gives:
- Better visualization
- More aggressive nerve removal
- Better control around major blood vessels
- Easier management of scar tissue or abnormal anatomy
The tradeoff:
- Larger incision
- More pain initially
- Longer recovery
Getting On My Nerves
Many specialists believe MALS is partly a neurogenic pain syndrome, not only a blood-flow problem.
The celiac plexus controls pain signaling from:
Stomach, Liver, Pancreas, & Small intestine
When chronically irritated, these nerves can become hypersensitive.
That is why some patients:
- Have severe pain despite only moderate artery narrowing
- Improve after celiac plexus blocks
- Benefit from ganglionectomy/neurolysis
Recovery
Recovery is typically longer than laparoscopic surgery.
Typical timeline:
- Hospital stay: 4–7+ days
- Full recovery: 6–12 weeks
- Lifting restrictions for several weeks
Common post-op symptoms:
- Significant abdominal soreness
- Fatigue
- Temporary digestive changes
- Diarrhea or altered bowel habits
- Appetite fluctuations
- Temporary nerve-related discomfort
Outcomes
Results vary significantly because MALS itself is complex.
Patients tend to do best when:
- Symptoms clearly fit MALS
- Imaging confirms severe compression
- Other GI disorders are ruled out
- A celiac plexus block provided temporary relief beforehand