Low IMA Ligation Did Not Significantly Reduce Leaks

A randomized trial found similar short-term morbidity and 12-month functional outcomes with both approaches, while highlighting the need to balance perfusion with a tension-free anastomosis.

By
Andrea Surnit
July 15, 2026
5 min

MDSpire News

Overview

A randomized trial found no significant difference in symptomatic anastomotic leakage rates between low and high inferior mesenteric artery ligation in minimally invasive rectal cancer surgery. Most 12-month patient-reported outcomes also showed no significant differences.

Background

Anastomotic leakage is a critical complication following colorectal cancer surgery, associated with increased morbidity and mortality. The choice of inferior mesenteric artery ligation level may influence surgical outcomes, making it essential to evaluate the implications of low versus high ligation techniques.

Data Highlights

Ligation Type	Symptomatic Anastomotic Leakage	30-Day Morbidity
Low Ligation	5%	14%
High Ligation	6%	22%

Key Findings

No statistically significant difference in symptomatic anastomotic leakage between low (5%) and high (6%) IMA ligation.
Overall 30-day morbidity was 14% for low ligation and 22% for high ligation, with no significant difference.
Splenic flexure mobilization was performed more frequently in the low-ligation group (57% vs 35%).
Patient-reported outcomes at 12 months showed no significant differences in bowel, urinary, sexual, or quality-of-life measures.
The trial may have been underpowered due to lower than expected leakage rates.

Clinical Implications

The findings suggest that both techniques can be utilized without significant differences in postoperative outcomes.

Conclusion

The study indicates that low IMA ligation does not provide a significant advantage over high ligation regarding anastomotic leakage and patient-reported outcomes.