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Sugiura procedure in portal hypertensive children
O F Senyüz1, E Yeşildag, H Emir
1Department of Pediatric Surgery, Cerrahpaşa Medical Faculty, Istanbul University, Istanbul, Turkey.
Insights
The Sugiura operation effectively treated bleeding esophageal varices in children unresponsive to endoscopic sclerotherapy. This surgical approach demonstrated a high success rate with low mortality, offering a viable treatment option for refractory portal hypertension cases.
Area of Science:
- Pediatric Gastroenterology
- Hepatology
- Surgical Gastroenterology
Background:
- Esophageal varices bleeding is a significant cause of mortality in pediatric portal hypertension.
- Treatment strategies vary based on the cause of portal hypertension (intrahepatic or extrahepatic).
- Endoscopic procedures are now the primary treatment, with surgery reserved for refractory cases.
Purpose of the Study:
- To retrospectively evaluate the efficacy of the Sugiura operation in children with portal hypertension and bleeding esophageal varices.
- To assess the Sugiura operation's impact on prognosis in patients refractory to endoscopic sclerotherapy.
Main Methods:
- Retrospective evaluation of 12 pediatric patients (6 intrahepatic, 6 extrahepatic portal hypertension) who underwent the Sugiura operation.
- Patients included were unresponsive to prior endoscopic sclerotherapy treatment.
Main Results:
- The Sugiura operation showed no rebleeding in 9 out of 12 patients (75%) post-procedure.
- The mortality rate was 8.3% (1 out of 12 patients), with death attributed to hepatic failure.
Conclusions:
- The Sugiura operation is an effective treatment for bleeding esophageal varices in children with portal hypertension who have failed endoscopic sclerotherapy.
- This surgical intervention offers a favorable prognosis with a low rebleeding rate and acceptable mortality in selected pediatric patients.
Abstract:
Bleeding from esophageal varices is an important cause of morbidity and mortality in children with portal hypertension. The treatment protocol is planned according to the etiologic factors underlying the portal hypertension, which may be either intrahepatic or extrahepatic. Although portasystemic venous shunt operations were common previously, they are now regarded as nonphysiologic and are rarely used because of their unexpected results and complications. Today, in many centers, endoscopic procedures have become the first-step treatment modality in bleeding esophageal varices. More complicated surgical procedures, such as devascularization procedures in extrahepatic portal hypertension, and liver transplantation in patients with failing liver, should be performed when conservative measures fail. We followed up 69 patients with portal hypertension with endoscopic sclerotherapy in our department. Here we present a retrospective evaluation of the effect of the Sugiura operation on the prognosis of 12 children (6 with extrahepatic and 6 with intrahepatic portal hypertension) who were not responsive to the sclerotherapy program. No rebleeding was seen in 9 of the 12 (75%) patients after the procedure, and the mortality rate in this series was 1 of 12 (8.3%); this patient died of hepatic failure.