Related Experiment Video
Updated: Oct 8, 2026
New Thrombectomy Technique for Total Portal Vein Thrombosis in Liver Transplantation
Published on: June 27, 2025
A modified technique of devascularization for surgical management of portal hypertension in children
D Sharma1, S Agrawal, A Saxena
1Department of Surgery, NSCB Government Medical College, Jabalpur, India. dhanshar@hotmail.com
Insights
This study presents a modified surgical devascularization technique for children with portal hypertension, effectively preventing variceal bleeding. The procedure demonstrated safety and efficacy, improving patients' quality of life with minimal complications.
Area of Science:
- Hepatology
- Surgical Gastroenterology
- Pediatric Surgery
Background:
- Portal hypertension in developing countries often necessitates surgical intervention for various indications.
- Variceal bleeding is a significant complication of portal hypertension, requiring effective prophylactic strategies.
Purpose of the Study:
- To prospectively evaluate a modified transabdominal oesophagogastric devascularization technique for secondary prophylaxis of variceal bleeding.
- To assess the safety and efficacy of this modified Sugiura procedure in pediatric patients with different etiologies of portal hypertension.
Main Methods:
- A modified Sugiura devascularization procedure involving extensive oesophagogastric devascularization and transmural ligation of varices was performed on 16 pediatric patients.
- The modification aimed to reduce operative time and avoid complications associated with oesophageal transection and anastomosis.
Main Results:
- The modified technique achieved zero operative mortality and zero oesophageal leak rates.
- One patient developed an oesophageal stricture; follow-up showed residual varices (2), recurrent varices (3), and one rebleeding event.
- Porto-systemic encephalopathy occurred in only one patient, indicating minimal impact.
Conclusions:
- This modified devascularization technique is a simple, safe, and effective surgical option for controlling variceal bleeding in pediatric patients with portal hypertension.
- The procedure offers good quality of life with a low incidence of porto-systemic encephalopathy.
Abstract:
In developing countries surgery is indicated in patients with portal hypertension for a variety of reasons. This study prospectively evaluates a modified technique of devascularization for secondary prophylaxis of variceal bleeding in patients with portal hypertension of different aetiologies. Transabdominal extensive oesophagogastric devascularization combined with transmural ligation of oesophageal and gastric varices was performed in 16 paediatric patients (nine with extrahepatic portal venous obstruction, and seven with non-cirrhotic portal fibrosis) in an elective setting. The Sugiura devascularization procedure was modified to minimize the operating time and to avoid the problems associated with oesophageal transection and anastomosis. The operative mortality rate as well as the oesophageal leak rate was zero. One patient developed an oesophageal stricture. During a 12-month follow-up, patients were seen with residual varices (2), recurrent varices (3) and rebleeding (1). Porto-systemic encephalopathy was seen in one patient only. This technique is a simple, straightforward, safe and effective modification of the Sugiura procedure in controlling bleeding, providing good quality of life with minimal porto-systemic encephalopathy.
Related Concept Videos
01:28Esophageal Varices-II: Clinical Features and Management
In the initial assessment, a thorough review of the patient's medical history is vital to identify risk factors such as liver disease, alcohol abuse, or...
01:22Portal Hypertension