**Study Summary** This study is about a condition called *Median Arcuate Ligament Syndrome (MALS)*. MALS happens when a band of tissue, called the *median arcuate ligament*, presses on a blood vessel called the *coeliac artery*. This can cause stomach pain after eating, weight loss, and tiredness. Doctors are not completely sure how to treat MALS, so this study will help find out if a surgery called *Coeliac Artery Release (eCAR)* is helpful. The study will compare this surgery to a "sham" operation, which means some patients will get a fake surgery to see if the real surgery is actually helpful. The study will track patients for up to two years to see if their symptoms improve. If the surgery works, it could help up to 490 people every year in the Netherlands, saving a lot of money on healthcare. - **Study Length**: Up to two years of follow-up. - **Risk**: Potential ongoing pain and weight loss if untreated. - **Eligibility**: Specific diagnosis confirmed by experts, with symptoms like stomach pain after eating, weight loss, or diarrhea. This study could change how MALS is treated in the future!