Abstract IN MARCH, 1947, one of us (J. K. B.) began investigating the effects of hepatic and splenic artery ligations on portal pressures in normal and in portal hypertensive dogs. Summaries of this work have been presented,1 and a report of our first case2 has been published. This paper is an account of our first 12 cases with advanced portal cirrhosis of the liver treated by hepatic, splenic, and left gastric arterial ligations. INDICATIONS AND CONTRAINDICATIONS These patients were operated upon because they were cirrhotics who did not respond to medical management, including use of cation-anion resins, and who, in addition, had symptoms and signs which are known to indicate a poor prognosis if allowed to persist or progress. The symptoms and signs in the order of their gravity were (1) rapid regression in the size of the liver; (2) bleeding varices or bleeding from the gastrointestinal tract; (3) References 1. (a) Berman, J. K.; Koenig, H., and Saint, W. K.: Ligation of the Hepatic and Splenic Arteries in the Treatment of Portal Hypertension , Indiana Univ. Quart. Bull. 12:99, 1950. 2. (b) Berman, J. K., in discussion on Grindlay, J. H.; Mann, F. C., and Bollman, J. L.: Effect of Occlusion of the Arterial Blood Supply to the Normal Liver: An Experimental Study , A. M. A. Arch. Surg. 62:806, 1951.Crossref 3. (a) Berman, J. K.; Muller, L. P.; Fisch, C., and Martz, W.: Ligation of the Hepatic and Splenic Arteries in a Patient with Atrophic Cirrhosis of the Liver , A. M. A. Arch. Surg. 63:623, 1951.Crossref 4. (b) Berman, J. K.; Koenig, and Muller, L.: Ligation of the Hepatic and Splenic Arteries in the Treatment of Portal Hypertension: Ligation in Atrophic Cirrhosis of the Liver , A. M. A. Arch. Surg. 63:379, 1951.Crossref 5. Moser, R. H.; Rosenak, B. D.; Pickett, R. D., and McIntire, C. R.: The Prognosis of Portal Cirrhosis: An Analysis of 62 Cases , Gastroenterology 18:86, 1951. 6. Ratnoff, O. D., and Patek, A. J., Jr.: The Natural History of Laennec's Cirrhosis of the Liver: An Analysis of 386 Cases , Medicine 21:207, 1942. 7. Patton, T. B., and Johnston, G. G.: A Method for Control of Bleeding from Esophageal Varices , Arch. Surg. 59:502, 1949.Crossref 8. Sengstaken, R. W., and Blakemore, A. H.: Balloon Tamponage for the Control of Hemorrhage from Esophageal Varices , Ann. Surg. 131:781, 1950.Crossref 9. Whitby, L. E. H., and Britton, C. J. C.: Disorders of the Blood , Ed. 5, Philadelphia, The Blakiston Company, 1946. 10. DeTakats, G.: Personal communication to the authors. 11. Markowitz, J.; Rappaport, A., and Scott, A. C.: Prevention of Liver Necrosis Following Ligation of Hepatic Artery , Proc. Soc. Exper. Biol. & Med. 70:305, 1949. 12. Berman.1a Ratnoff.4 13. (a) Altemeier, W. A.: Personal communication to the authors. 14. (b) Reynolds, J.: Personal communication to the authors. 15. (c) Swan, H.: Personal communication to the authors. 16. (d) Benson, C.: Personal communication to the authors. 17. (e) Rienhoff, W. F.: Ligation of the Hepatic and Splenic Arteries in the Treatment of Portal Hypertension with a Report on 6 Cases , Bull. Johns Hopkins Hosp. 88:368, 1941. 18. Preshaw, D. E.; Large, A., and Johnson, A. F.: Effect of Portacaval Venous Shunt on Sulfobromophthalein (Bromsulphalein®) Retention , A. M. A. Arch. Surg. 62:801, 1951. 19. Bradley, S. E.; Ingelfinger, F. J.; Bradley, G. P., and Curry, J. J.: The Estimation of Hepatic Blood Flow in Man , J. Clin. Invest. 24:890, 1945. 20. Bradley, S. E.: Variations in Hepatic Blood Flow in Man During Health and Disease , New England J. Med. 240:456, 1951. 21. Habif, D. V.; Papper, E. M.; Fitzpatrick, H. F.; Lowrance, P.; Smythe, C. McC., and Bradley, S. E.: The Renal and Hepatic Blood Flow, Glomerular Filtration Rate and Urinary Output of Electrolytes During Cyclopropane, Ether, and Thiopental Anesthesia, Operation and the Immediate Postoperative Period , Surgery 30:241, 1951. 22. Berman, J. K., and Hull, J. E.: Circulation in the Normal and Cirrhotic Liver, Ann. Surg., to be published. 23. Grindlay, J. H.; Mann, F. C., and Bollman, J. C.: Discussion Before the Central Surgical Association, Chicago, Feb. 23, 1951.
A.M.A. Archives Surgery – American Medical Association
Published: Jul 1, 1952
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