Hepatic Artery Ligation – Myths Disproved – An Experimental study in Dogs.

Abstract

The usual myths surrounding the procedure of selective hepatic artery ligation (SHAL) are hepatic necrosis, failure and high incidence of septic complications resulting in increased morbidity and mortality. We conducted an experimental study in twelve healthy mongrel dogs to determine the postoperative sequalae and to ascertain the validity of traditional concepts/ myths about SHAL. Lobar branch of the hepatic artery to left lateral lobe of liver was ligated in all the dogs and postoperative outcome was studied for three months. Indices like postoperative recovery, serial enzymatic changes and mortality were our guiding principles to determine the pathophysiological derangements and improvements after SHAL. Serial autopsies after sacrificing the animals were performed to determine the gross abnormalities in the affected lobe of liver. All the dogs had smooth postoperative recovery without any gross abnormalities in the liver, septic complications or mortality. However, significant transient changes in serum enzyme levels during early postoperative period were detected. There was no evidence of permanent hepatic dysfunction/ damage after SHAL. This study has disproved many myths surrounding the procedure of selective hepatic artery ligation. Therefore, we recommend its use as a primary means of securing haemostasis in most of the major liver injuries. It may prove to be a simple life saving procedure in such injuries without increased morbidity and mortality, especially at peripheral hospitals where facilities are deficient and experienced surgeons are usually not available.