Related Experiment Videos
Modified Sujura operation: long-term results
G Battaglia1, E Ancona, E Patarnello
1Department of General Surgery II, University of Padua, Italy.
Insights
The modified Sujura
Area of Science:
- Gastroenterology
- Surgical Gastroenterology
- Hepatology
Background:
- Portal hypertension is a serious complication of liver disease.
- Esophageal varices are a common and life-threatening manifestation of portal hypertension.
- Effective surgical management is crucial for improving outcomes.
Purpose of the Study:
- To evaluate the efficacy and safety of a modified Sujura's operation for treating portal hypertension.
- To assess the rates of rebleeding, mortality, and long-term survival after the procedure.
Main Methods:
- A cohort of 93 patients with portal hypertension and esophageal varices underwent a modified Sujura's operation between 1980 and 1986.
- The surgical technique involved devascularization, pyloric divulsion, esophagogastric resection and anastomosis, and antireflux fundoplication.
- Splenectomy was added for severe hypersplenism.
Main Results:
- Early mortality was 19.8%, with higher rates in emergency operations (27.2%).
- Long-term follow-up showed a 36.6% rebleeding rate, with esophageal varices and hemorrhagic gastritis being common causes.
- Five-year survival for elective procedures was 59.2%, and 10-year survival was 40.7%.
Conclusions:
- The modified Sujura's operation is a viable option for managing portal hypertension, but carries significant risks of early mortality and late rebleeding.
- Careful patient selection and management of complications are essential for optimizing outcomes.
- Further research into alternative or adjunct therapies may be warranted.
Abstract:
From January 1980 to January 1986 a total of 93 patients with portal hypertension (59 males, 34 females; average age 51.5 years) underwent the modified Sujura's operation. All patients presented with esophageal varices during the preoperative endoscopic workup. Child's risk category was A in 6 patients and B in the remaining 87. Our technique consisted of: (1) devascularization of the upper half of the gastric corpus and fundus; (2) devascularization of the last 10 to 12 cm of the thoracic esophagus; (3) pyloric divulsion; (4) resection and anastomosis at the esophagogastric junction; and (5) antireflux fundoplication. In the presence of severe hypersplenism we added splenectomy. The surgical approach was through a xiphoumbilical laparotomy, extended to the left side when splenectomy was anticipated. We observed 19.8% early mortality (10% with elective procedures and 27.2% with emergency operations) and two cases of early rebleeding from acute mucosal lesions. Long-term follow-up of 82 patients revealed 30 cases of rebleeding (36.6%). Ruptured esophageal varices occurred in 12 patients (11 were treated with endoscopic sclerotherapy), whereas in 11 patients the cause of bleeding was a hemorrhagic gastritis. Of the remaining patients, two had rebleeding from a gastric ulcer, one from gastric varices, one from duodenal varices; in three patients the source of the hemorrhage remains unknown. The survival for elective procedure patients was 59.2% at 5 years and 40.7% at 10 years.