Hypogastric Artery Ligation
This operation is usually performed as an emergency procedure for postpartum hemorrhage in lieu of hysterectomy. It also may be performed for nonobstetric uncontrolled bleeding (e.g., postirradiation hemorrhage, vaginal laceration bleeding, cervical bleeding, posthysterectomy bleeding). Hypogastric ligation affects clotting by reducing ipsilateral pulse pressure (85% decrease) and blood flow (50% decrease).
The operation requires a laparotomy. The retroperitoneum is entered by opening the peritoneum above the external iliac artery over the psoas major muscle (Fig. 20–1). The external iliac artery and vein are exposed in the direction of the bifurcation of the common iliac artery (Fig. 20–2). As the dissection proceeds cranially, the ovarian vessels and the ureter are encountered as they cross the common iliac artery (Fig. 20–3). The external iliac artery is retracted with a vein retractor to expose the hypogastric artery (Fig. 20–4). A long right-angle clamp is used to carefully dissect a plane between the common hypogastric artery and its underlying vein (Fig. 20–5
