Esophageal transection with paraesophagogastric devascularizations (the Sugiura procedure) in the treatment of esophageal varices.

Abstract

AbstractThe Sugiura procedure was performed in 671 patients with esophageal varices. Of these, 203 (30%) had prophylactic, 363 (54%) had elective, and 105 (16%) had emergency procedures. Portal hypertension was due to liver cirrhosis in 495‐alcoholic in 52 and cryptogenic in 443‐idiopathic portal hypertension in 100, extrahepatic portal vein occlusion in 39, hepatoma in 23, schistosomiasis in 4, Budd‐Chiari syndrome in 3, and other causes in 7. Operative mortality rate was as follows: emergency, 13.3%; elective, 3.0%; prophylactic, 3.9%; overall, 4.9%. The operative mortality rate by Child's classification was 0% for 244 class A patients, 2% for 251 class B patients, and 16% for 176 class C patients. There were no operative deaths in prophylactic cases of class A and B. The 10‐year actuarial survival rate in patients with liver cirrhosis was 55% in emergency cases, 72% in prophylactic cases, and 72% in elective cases. The similar survival rate in patients without cirrhosis was 90% in emergency cases, 96% in prophylactic cases, and 95% in elective cases. The incidence of recurrent variceal bleeding was only 1.5%, and 5.2% had recurrent varices. There was no postoperative variceal bleeding in prophylactic cases. Five class C patients with suture insufficiency developed empyema and died. Our procedure is safe and effective in controlling esophageal varices and able to prolong the long‐term survival.