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Ligation – Definition, Types and Procedure

Ligation is a surgical technique in which a thread or loop is tied around a vessel or tissue to stop bleeding or permanently close a structure.

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Things worth knowing about "Ligation"

Ligation is a surgical technique in which a thread or loop is tied around a vessel or tissue to stop bleeding or permanently close a structure.

What is Ligation?

Ligation (from Latin ligare = to bind) is a medical procedure in which a suture, thread, loop, or clip is used to tie off a blood vessel, tissue strand, or other anatomical structure. The goal is to interrupt blood flow, stop bleeding, or permanently seal a specific structure. It is one of the most fundamental techniques in surgery and is applied across numerous surgical specialties.

Fields of Application

Ligation is used in many medical areas:

Vascular surgery: Tying off blood vessels to achieve hemostasis during operations or after injuries.
General surgery: Closing vascular stumps after removal of organs or tissue sections.
Urology: Ligation of the vas deferens (vasectomy) for permanent male contraception.
Gynecology: Tubal ligation as a method of permanent female contraception.
Gastroenterology / Endoscopy: Rubber band ligation for hemorrhoids or esophageal varices (enlarged veins in the esophagus) to treat or prevent bleeding.
Dentistry and orthodontics: Use of ligatures (wires or elastic rings) to secure orthodontic archwires to brackets.

How is Ligation Performed?

The procedure varies depending on the area of application. In classic surgery, a resorbable or non-resorbable suture material (e.g., polyglactin, polyester, or silk) is tied firmly around a vessel or tissue strand, interrupting the supply of blood or other fluids. The constricted area becomes necrotic due to lack of oxygen and eventually falls off or is surgically removed.

In endoscopic ligation (e.g., rubber band ligation), a small elastic band is placed around the target tissue using an endoscope. This method is particularly used for treating hemorrhoids and esophageal varices and generally does not require general anesthesia.

Types of Ligation

Vascular ligation: Tying off arteries or veins to stop bleeding.
Tubal ligation: Sterilization procedure in women by tying off the fallopian tubes.
Vasectomy (vas deferens ligation): Sterilization procedure in men.
Rubber band ligation: Endoscopic treatment of hemorrhoids or esophageal varices.
Orthodontic ligation: Fixation of orthodontic archwires with wires or elastic rings.

Risks and Complications

As with any surgical procedure, ligation carries potential risks. Possible complications include:

Post-operative bleeding if the suture loosens or slips.
Infection at the ligation site.
Tissue damage from unintentional constriction of adjacent structures.
In tubal ligation or vasectomy: rare procedure failure resulting in unintended pregnancy.
In rubber band ligation: temporary pain, pressure sensation, or bleeding after the procedure.

Follow-up Care

Follow-up care depends on the specific procedure performed. After endoscopic rubber band ligation for hemorrhoids or esophageal varices, regular follow-up examinations are generally recommended to verify treatment success. After sterilization procedures such as tubal ligation or vasectomy, the success of the procedure should be confirmed through appropriate testing (e.g., semen analysis after vasectomy).

References

Townsend, C. M. et al.: Sabiston Textbook of Surgery. 21st Edition. Elsevier, 2021.
World Health Organization (WHO): Family planning / Contraception fact sheets. Available at: https://www.who.int (2023).
Laine, L.; Cook, D.: Endoscopic ligation compared with sclerotherapy for treatment of esophageal variceal bleeding. Annals of Internal Medicine, 123(4): 280-287, 1995. PubMed PMID: 7611595.

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