How Abu Dhabi doctors solved a 40kg weight-loss mystery with robotic surgery

For months, a 32-year-old patient had no answers, only worsening symptoms: Severe pain in the upper abdomen, reflux, nausea and an inability to tolerate food. And a weight loss that had climbed past 40 kilograms, despite multiple consultations and rounds of tests elsewhere that turned up nothing definitive.

By the time the patient arrived at Sheikh Shakhbout Medical City (SSMC) — a flagship hospital in the UAE for complex care, and a subsidiary of PureHealth, the case had become one of those diagnostic puzzles that medicine dreads: Symptoms severe enough to demand answers, but common enough to mimic half a dozen other conditions.

The eventual diagnosis was Median Arcuate Ligament Syndrome (MALS), a rare vascular condition in which a fibrous band near the diaphragm compresses the celiac artery and the nerves around it. It's a condition that can cause exactly what this patient was experiencing: severe pain after eating, nausea, vomiting, reflux, and dramatic weight loss. However, as those symptoms overlap so heavily with more common gastrointestinal disorders, MALS is notoriously easy to miss.

Getting to the diagnosis wasn't the work of a single specialist, it took a team pulled from four different disciplines: Gastroenterology, Vascular Surgery, Radiology and Robotic Surgery, working through the case together: After a detailed review of cross-sectional imaging and dynamic vascular duplex assessment, the team confirmed what they suspected: significant compression of the celiac artery, consistent with MALS. Even then, the case went through further multidisciplinary review to rule out other gastrointestinal explanations before settling on a treatment path.

Dr. Mohamed Baguneid, Chair of the Vascular Surgery Division at SSMC, said the case is a reminder of how easily MALS can slip through the cracks. "Median Arcuate Ligament Syndrome is a rare condition that can often go undiagnosed because its symptoms overlap with a number of more common gastrointestinal disorders," he explained in a press statement. "Cases like this highlight the importance of multidisciplinary collaboration, advanced diagnostic capabilities and specialist expertise in identifying the root cause of complex presentations. Bringing together specialists from multiple disciplines allowed us to reach a diagnosis and develop a treatment plan tailored to the patient's needs."

Once the diagnosis was confirmed, the patient underwent robotic-assisted release of the median arcuate ligament, a procedure performed by SSMC's robotic surgery team, led by Dr. Salem Al Harthi. The robotic approach gave surgeons the precision to dissect around the compressed artery and the surrounding nerve fibres while keeping surgical trauma to a minimum. The operation was completed with minimal blood loss and no complications.

Dr. Al Harthi, Consultant Robotic Surgeon and Chair of the Surgery Department at SSMC, pointed to exactly why that precision mattered in a case like this. "Robotic-assisted surgery enables us to manage highly complex cases with exceptional precision that is particularly crucial when operating around critical vascular and nerve structures," he said. "In this case, the technology enabled a minimally invasive approach while supporting careful dissection and preservation of surrounding anatomy. Combined with multidisciplinary planning, it allowed us to deliver a highly tailored treatment approach for the patient."

The result: At follow-up, the patient reported being pain-free, back to tolerating a normal diet, and seeing significant improvement across the board, including in the reflux, nausea and excessive salivation that had defined months of uncertainty.