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A modified Sugiura operation for bleeding varices in children
Insights
This study presents a modified Sugiura operation for children with bleeding esophageal varices, offering a simpler, effective surgical solution. The technique successfully prevented rebleeding while preserving gastrointestinal function.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Hepatology
Background:
- Esophageal varices hemorrhage poses a life-threatening risk in children.
- Traditional portal systemic shunting has limitations, including encephalopathy and inadequacy in young children.
Purpose of the Study:
- To present a modified Sugiura operation for pediatric patients with bleeding esophageal varices.
- To evaluate the safety and efficacy of this surgical technique.
Main Methods:
- Eight children underwent a modified Sugiura operation for bleeding varices caused by portal vein thrombosis, congenital hepatic fibrosis, chronic active hepatitis, or cystic fibrosis.
- The modified technique involves a single thoracoabdominal incision, stapler-assisted esophageal anastomosis, preserved vagal innervation, and gastric fundus wrapping.
Main Results:
- The modified operation was shorter and simpler than the original Sugiura procedure.
- No evidence of rebleeding from esophageal varices was observed in the long term.
- Complications included one anastomotic leak and one esophageal stricture.
Conclusions:
- The modified Sugiura operation is a preferred surgical therapy for pediatric bleeding esophageal varices.
- This technique preserves upper gastrointestinal tract structure and function, as well as portal venous drainage to the liver.
Abstract:
Objections to portal systemic shunting in children with life-threatening hemorrhage from esophageal varices include the high incidence of postshunt encephalopathy with neurologic and psychiatric sequelae and the inability to provide an adequate shunt in very young children. We have operated on eight children in the past 4 years for bleeding varices. The causes were: portal vein thrombosis (3), congenital hepatic fibrosis (2), chronic active hepatitis (2), and cystic fibrosis (1). The ages at operation were between 2 and 17 years. These children underwent various modifications of an operation described by Sugiura. The operation we have developed is done through a single thoracoabdominal incision, dividing and anastomosing the esophagus with a stapler, preserving the vagal innervation to the pylorus and antrum, and wrapping the fundus around the distal esophagus at the site of the anastomosis. The venous drainage of the lower esophagus and of the upper stomach is divided. The operation is therefore shorter and simpler, but adheres to the principles enunciated by Sugiura. Complications include one significant postoperative anastomotic leak and one symptomatic esophageal stricture. Longterm results have been gratifying with no evidence of rebleeding from esophageal varices. We believe that our modification of the original Sugiura operation is the preferred therapy of bleeding esophageal varices when surgical intervention is indicated because it preserves the normal structure and function of the upper gastrointestinal tract as well as the portal venous drainage to the liver.