An alternate low risk technique for esophageal transection in the Sugiura-Futagawa procedure

The Sugiura-Futagawa procedure is an effective non-shunting operation to treat bleeding esophageal varices. The goal of the esophageal transection is the interruption of submucosal varices. The rate of esophageal fistula reported after transection is 5 to 8 per cent. This complication has high morbidity and mortality rates. The technique and results of an alternate variant of the esophageal transection are described. After devascularization of the esophagus is achieved, the anterior muscular layer is opened, and the entire mucosal cylinder is dissected free from the muscular layer. Without opening the mucosa, a circumferential continuous running suture with fine non-absorbable material is placed, involving both mucosa and submucosa, interrupting the varicose veins. Our experience with this technique has been encouraging, having observed no stenosis or fistulization in 10 patients on whom we operated. Re-bleeding rate is low (10% in this series). The advantages of this modification are: 1) since we do not cut open the mucosal layer, we believe that the risk of fistulization is reduced, and 2) it allows an early initiation of oral feeding, thus reducing the hospital stay.