Further evaluation of the Sugiura procedure in the treatment of esophageal varices.

Abstract

• A total of 276 patients had an esophageal transection with paraesophagogastric devascularization (the Sugiura procedure) for esophageal varices from 1967 to the present; 60 procedures were prophylactic, 164 were elective, and 52 were emergency procedures. The age distribution was from 9 months to 74 years. The origin was cirrhosis in 191 patients, fibrosis in 59, extrahepatic portal vein occlusion in 18, hepatoma in five, schistosomiasis in one, Budd-Chiari syndrome in one, and carcinoma of the pancreas in one patient. The mortality within one month of operation was 5.0% in prophylactic cases, 1.8% in elective cases, and 11.5% in emergency cases (mean, 4.3%). The actuarial seven-year survival rate was 83%. There was an obvious positive correlation between survival rate and stage of the disease. Ninety-five percent of class A (Child's classification) and 87% of class B are alive, but only 59% of class C patients are alive at the present. Six patients had recurrences of varices for a recurrence rate of 2.3%, of whom four had esophageal bleeding. It may be that recurrence of varices occurred due to incomplete devascularization of the esophagus at the diaphragm because of the necessity of two-stage operations in poor-risk patients. All survivors are free from encephalopathy. The present study reconfirmed that our method is safe and effective in controlling esophageal variceal bleeding without compromising hepatic function. ( Arch Surg 112:1317-1321, 1977)