Collateral circulation after division of the common hepatic artery--clinical study concerning Appleby's operation

The alteration of the blood flow of the proper hepatic artery (PHA) on occlusion of the common hepatic artery (CHA) was studied intraoperatively using an electromagnetic flowmeter for 18 cases of malignant gastric tumor. PHA blood flow was 280 +/- 225 ml/min before CHA occlusion, and after the occlusion it was 170 +/- 132 ml/min, or 64 +/- 15% of the pre-occlusion flow (n = 16). The pulsation of PHA after CHA occlusion was palpable in all cases, and there were no complications due to ischemia in 17 cases which underwent Appleby's operation. These results suggested that there was fairly good blood flow in PHA maintained by collaterals after CHA occlusion and that, clear pulsation of PHA could be regarded as evidence of sufficient blood flow. Tissue blood flow (TBF) measurement for the liver and gall-bladder by H2 gas clearance method was also done in several cases of Appleby's operation and of other abdominal operations. TBF of the gallbladder was significantly lower in cases of Appleby's operation on the day of operation (p less than 0.02), but the difference between the two operation groups was not recognized 5 days after surgery, suggesting rather quick recovery of circulation. As to hepatic TBF, significant decrease following Appleby's operation could not be proved.