Hepatic, Splenic, and Left Gastric Arterial Ligations in Advanced Portal Cirrhosis

Ischemic necrosis of proximal gastric remnant following subtotal gastrectomy with splenectomy

“…Berman [20] did not observe necrosis of the stomach when treating portal cirrhosis by ligation of the left gastric, hepatic, and splenic arteries. Somerwell [2 11 treated many cases of duodenal ulcer by extensive devascularization of the stomach and gastroenterostomy, without observing gastric infarction.…”

Collateral arterial pathways to the liver after ligation of the hepatic artery and removal of the celiac axis

“…1, and Vol. 6 from an aberrant left hepatic arising from the left gastric, or from an accessory left gastric given off by the left hepatic. 2.…”

“…If the hepatic has been ligated proximal to the origin of the gastroduodenal, blood from the superior mesenteric via the cited routes may enter into the residual severed hepatic or the Vol. 6 hepatic branch that gave off the gastroduodenal and thus reach the liver.…”

“…from the mid-line, courses along the lateral border of the ensiform process and caudal to the latter proceeds downward to supply the fat body in the falciform ligament. 6. Through arteries coursing in the layers of peritoneum reflected over the liver (coronary ligament, right and left triangular ligaments).…”

Surgical Method for Management of Patients with Portal Cirrhosis

“…The rational basis for this surgical method can be traced back to the studies of the intrahepatic circulation in portal cirrhosis by Kretz (1904), Herrick (1907), Mclndoe (1928), andDock (1947), and to the more recent demonstration by Montagnani and Paci (1952) of a tremendous increase in the arterial circulation in the cirrhotic liver with widespread arterio-portal shunts of varying size. Berman et al (1950Berman et al ( , 1951 and Berman and Hull (1952) have suggested that the method works by reducing arterial blood flow and pressure in the liver parenchyma so that more blood can pass through the portal bed and portal venous pressure is lowered.…”