Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2012 Mar;36(3):659-66.
doi: 10.1007/s00268-011-1418-7.

Long-term results with the modified Sugiura procedure for the management of variceal bleeding: standing the test of time in the treatment of bleeding esophageal varices

D Voros  1 , A Polydorou, G Polymeneas, I Vassiliou, A Melemeni, K Chondrogiannis, V Arapoglou, G P Fragulidis
Affiliations

Long-term results with the modified Sugiura procedure for the management of variceal bleeding: standing the test of time in the treatment of bleeding esophageal varices

D Voros et al. World J Surg. 2012 Mar.

Abstract

Background: The surgical approaches to the treatment of bleeding esophageal varices in cirrhotic patients have been reduced since the clinical development of endoscopic sclerotherapy, transjugular intrahepatic portosystemic shunt (TIPS), and liver transplantation. However, when acute sclerotherapy fails, and in cases where no further treatment is accessible, emergency surgery may be life saving. In the present study we retrospectively analyzed the results of the modified Sugiura procedure, performed as emergency and semi-elective treatment in the patient with bleeding esophageal varices.

Methods: Ninety patients with cirrhosis and portal hypertension were managed in our department for variceal esophageal bleeding between January 1985 and December 1992. The modified Sugiura procedure was performed in 46 patients on an emergency (25 patients) or semi-elective (21 patients) basis. Liver cirrhosis stage according to Child classification was A in 4 patients, B in 16 patients, and C in 26 patients.

Results: Acute bleeding was controlled in all patients. Postoperative mortality was 23.9% (11 of 46 patients). The mortality rate was 34.6% in Child class C patients (9 of 26 patients), and 12.5% in Child class B patients (2 of 16 patients). Twenty-four patients had long-term follow-up extending from 14 months to 22 years (mean 83.1 months). Ten of 24 patients (41.6%) did not develop rebleeding for 5-22 years (mean 10.3 years). Overall 5-year survival in these 24 patients was 62.5%.

Conclusions: The modified Sugiura procedure remains an effective rescue therapy for patients with bleeding esophageal varices when alternative treatments fail or are not indicated. Moreover, it can be a life-saving procedure in patients with anatomy unsuitable for shunt surgery or for patients treated in nonspecialized centers where surgical expertise for a shunt operation is not available.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Flow diagram of the management of patients with esophageal bleeding
Fig. 2
Fig. 2
Kaplan–Meier curve showing: a survival of the 24 patients with long-term follow-up (n = 24). The Child class A patient survived for 12 years. b Survival of the 46 patients who underwent the modified Sugiura procedure (n = 46). Intraoperative and in-hospital postoperative deaths are included
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Wolff M, Hirner A. Current state of portosystemic shunt surgery. Langenbecks Arch Surg. 2003;388:141–149. doi: 10.1007/s00423-003-0367-5. - DOI - PubMed
    1. Bosch J, Berzigotti A, Garcia-Pagan JC, et al. The management of portal hypertension: rational basis, available treatments and future options. J Hepatol. 2008;48(Suppl 1):S68–S92. doi: 10.1016/j.jhep.2008.01.021. - DOI - PubMed
    1. Rosemurgy AS, Zervos EE. Management of variceal hemorrhage. Curr Probl Surg. 2003;40:263–343. doi: 10.1016/S0011-3840(03)00012-1. - DOI - PubMed
    1. Wright AS, Rikkers LF. Current management of portal hypertension. J Gastrointest Surg. 2005;9:992–1005. doi: 10.1016/j.gassur.2004.09.028. - DOI - PubMed
    1. Burroughs AK, Vangeli M. Transjugular intrahepatic portosystemic shunt versus endoscopic therapy: randomized trials for secondary prophylaxis of variceal bleeding: an updated meta-analysis. Scand J Gastroenterol. 2002;37:249–252. doi: 10.1080/003655202317284138. - DOI - PubMed

Publication types

MeSH terms