Introduction/Background The internal iliac artery (IIA) is the main arterial vessel of the pelvis. In cases of severe obstetrical or gynecologic hemorrhage, IIA ligation can be a lifesaving procedure. The study aims to investigate the role of IIA ligation in gynecologic oncology surgery.

Methodology This is a retrospective study (1.01.2019- 1.10.2023), which included 29 patients, referred to our institution, who underwent IIA ligation. The procedure was performed in 16 patients with cervical cancer, 6 patients with ovarian cancer, 3 patients with endometrial cancer, 3 women with uterine sarcomas, and 1 patient with vaginal cancer. Abdominal radical hysterectomy (type C1/C2) or simple total hysterectomy with bilateral salpingo-oophorectomy were done in 14 and 13 patients, respectively. Extraperitoneal bilateral ligation of the artery was performed as a palliative procedure in two patients with locally advanced cervical cancer and severe vaginal bleeding.

Results The median age of women was 60 years. In three patients (10.3%), the artery was bilaterally ligated during relaparotomy for postoperative bleeding. Bilateral ligation was performed in 24 (83%) women, whereas unilateral was done in 5 women. In 24 patients(83%), the artery was ligated above the posterior branch of the IIA, while in 5 (17%) women, the artery was ligated below the branch. There were no intraoperative complications. Two patients had persistent but decreased bleeding after the procedure. Bilateral IIA ligation significantly reduces blood loss in three cases of uterine sarcomas and two cases with vaginal bleeding due to advanced cervical cancer.

Conclusion IIA ligation above the posterior branch is not associated with postoperative ischemic complications to pelvic visceral organs and the buttocks. The procedure leads to a cessation of severe bleeding from pelvic gynecological malignancies. Bilateral IIA ligation still has applications in gynecologic oncology surgery, especially as a palliative procedure in developing countries with a high incidence of advanced cervical cancer cases.

Disclosures The authors have no relevant financial or non-financial interests to disclose.