Level of arterial ligation in rectal cancer surgery: Low tie preferred over high tie. A review

MM Lange, Mark Buunen, CJH van de Velde, Johan Lange

Research output: Contribution to journalArticleAcademicpeer-review

174 Citations (Scopus)
15 Downloads (Pure)


Consensus does not exist on the level of arterial ligation in rectal cancer surgery. From oncologic considerations, many surgeons apply high tie arterial ligation (level of inferior mesenteric artery). Other strategies include ligation at the level of the superior rectal artery, just caudally to the origin of the left colic artery (low tie), and ligation at a level without any intraoperative definition of the inferior mesenteric or superior rectal arteries. Publications concerning the level of ligation in rectal cancer surgery were systematically reviewed. Twenty-three articles that evaluated oncologic outcome (n=14), anastomotic circulation (n=5), autonomous innervation (n=5), and tension on the anastomosis/anastomotic leakage (n=2) matched our selection criteria and were systematically reviewed. There is insufficient evidence to support high tie as the technique of choice. Furthermore, high tie has been proven to decrease perfusion and innervation of the proximal limb. It is concluded that neither the high tie strategy nor the low tie strategy is evidence based and that low tie is anatomically less invasive with respect to circulation and autonomous innervation of the proximal limb of anastomosis. As a consequence, in rectal cancer surgery low tie should be the preferred method.
Original languageUndefined/Unknown
Pages (from-to)1139-1145
Number of pages7
JournalDiseases of the Colon & Rectum
Issue number7
Publication statusPublished - 2008

Research programs

  • EMC MM-03-47-02-A
  • EMC MM-03-47-06-A
  • EMC MM-03-47-11

Cite this