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A modified Sugiura procedure

R J Ginsberg, P F Waters, R A Zeldin

    The Annals of Thoracic Surgery
    |September 1, 1982
    PubMed
    Summary
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    This modified Sugiura procedure for esophageal varices offers good results by preserving beneficial shunts. It avoids recurrence of bleeding and hepatic encephalopathy in most patients.

    Area of Science:

    • Gastroenterology
    • Surgical Innovation
    • Hepatology

    Background:

    • Esophageal varices pose a significant bleeding risk in patients with portal hypertension.
    • The traditional Sugiura procedure aims to control variceal bleeding by creating shunts.
    • Modifications are needed to improve outcomes and reduce complications.

    Purpose of the Study:

    • To present a modified Sugiura procedure for managing esophageal varices.
    • To evaluate the efficacy and safety of this novel surgical approach.
    • To assess the impact on recurrent bleeding and hepatic encephalopathy.

    Main Methods:

    • A modified Sugiura procedure involving proximal gastric vagotomy and stapled esophagogastric anastomosis.
    • Esophagogastric devascularization without dividing main vagus trunks.

    Related Experiment Videos

  • Use of a circular End-to-End Anastomosis stapler and fundal wrap for esophageal anastomosis.

    • Main Results:

    • 15 out of 20 patients achieved good to excellent outcomes.
    • Rapid recovery and no recurrence of esophagogastric bleeding or hepatic encephalopathy observed.
    • Four high-risk patients (Child's C, massive bleeding) experienced postoperative mortality.

    Conclusions:

    • The modified Sugiura procedure is a promising surgical option for esophageal varices.
    • Preservation of hepatic blood flow and beneficial shunts is conceptually advantageous.
    • The procedure should be cautiously considered for end-stage patients with massive bleeding.