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Experience with the esophagogastric devascularization procedure.

D J Barbot, E F Rosato

    Surgery
    |June 1, 1987
    PubMed
    Summary
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    The modified Sugiura procedure for esophageal varices showed a 32% operative mortality, with complications mainly from esophageal transection. Survivors had stable liver function, indicating potential long-term benefits for portal hypertension management.

    Area of Science:

    • Gastroenterology
    • Hepatology
    • Surgical Gastroenterology

    Background:

    • Esophageal varices are a serious complication of liver cirrhosis, posing a significant risk of life-threatening hemorrhage.
    • The Sugiura procedure, a surgical approach, has been used to manage esophageal varices, but its outcomes require evaluation.

    Purpose of the Study:

    • To assess the efficacy and safety of a modified Sugiura procedure for treating esophageal varices.
    • To analyze the operative mortality, morbidity, and long-term outcomes in patients undergoing this surgical intervention.

    Main Methods:

    • A modified Sugiura procedure involving esophageal and gastric devascularization was performed on 28 consecutive patients.
    • Patients were classified using Child's classification, and etiological factors for cirrhosis were recorded.

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  • Operative time, blood replacement, and complications were meticulously documented.

    • Main Results:

    • The operative mortality rate was 32%, with higher rates in Child's class C patients.
    • Morbidity occurred in 33% of patients, primarily due to complications from esophageal transection.
    • Among survivors, long-term bleeding was infrequent, and liver function remained stable.

    Conclusions:

    • The modified Sugiura procedure is associated with significant operative mortality and morbidity, particularly related to esophageal transection.
    • Omitting esophageal transection in later cases may improve outcomes.
    • Despite risks, the procedure can lead to stable liver function and controlled varices in surviving patients.