Consensus Statement on Precision Anatomy and Treatment Strategies for Median Arcuate Ligament Syndrome: AOB Consensus Meeting.

BACKGROUND: With the increasing use of minimally invasive surgery, understanding of the precise anatomy involved in median arcuate ligament syndrome (MALS) has advanced. However, surgical strategies and treatment principles for MALS remain unclear. METHODS: At the 37th Annual Meeting of the Japan Society for Endoscopic Surgery, an expert consensus conference titled "AOB Consensus Meeting" was held. Eleven experts in upper gastrointestinal, hepatobiliary-pancreatic, and vascular surgery discussed five clinical questions (CQs) regarding MALS. Systematic literature reviews were conducted, and draft consensus statements were developed. Evidence levels were assessed based on the MINDS guideline, and final consensus statements were established through a second-round Delphi voting process. RESULTS: Thirteen consensus statements were formulated across the five CQs, all achieving over 75% agreement among the experts. CONCLUSION: This consensus provides evidence- and experience-based recommendations for the diagnosis and surgical treatment of MALS. These consensus statements are expected to serve as a practical guide for specialists and surgeons, promoting the safe execution and appropriate global dissemination of MALS treatment.