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December 1963

Control of Bleeding in Suprapubic Prostatectomy: Use of Bilateral Ligation of the Hypogastric Arteries

Author Affiliations


Arch Surg. 1963;87(6):887-891. doi:10.1001/archsurg.1963.01310180003002

The control of bleeding during and after suprapubic prostatic surgery is often difficult to accomplish. The methods currently used to control bleeding present many problems and add greatly to postoperative discomfort. Bilateral ligation of the hypogastric arteries during surgery has resulted in a marked decrease in bleeding during and following suprapubic prostatectomy. Patient discomfort has been greatly reduced.

Reich and Nechtow1 reported nine cases of alarming gynecologic and obstetrical hemorrhage which were controlled by ligation of one or both hypogastric arteries. They noticed no ill effects from this procedure.


Extraperitoneal Approach.  —A low midline incision is made from pubis to umbilicus. The rectus muscle is retracted laterally. The posterior rectus sheath is carefully incised just above its lower border, thus entering the preperitoneal space (Fig 1). The incision is carried upward the length of the wound. It is then extended inferiorly, dividing the thin ill-defined transversalis fascia below

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