Elective treatment of bleeding varices with the Sugiura operation over 10 years.
A 10-year experience with the devascularization operation described by Sugiura is reported here. The operation was performed electively in 100 patients in whom it was not possible to place a shunt, all of whom had different kinds of hepatopathies (63 Child's A, 32 Child's B, and 5 Child's C). In 15 patients, the procedure was done in one stage (6% operative mortality, 1 patient), and, in 51, it was performed in two stages. Eight deaths were recorded in the 63 patients of the Child's A group, with a total of 111 operations. The operative mortality rate for this group was 12% and, as related to the number of operative procedures, 7% (8 of 111 operations). Seventeen patients were not considered for a second stage. Rebleeding in the early postoperative period was 4% and at long-term 6%. Incapacitating encephalopathy was found in 2 of the 71 surviving patients (3%). Survival (as determined by Kaplan-Meier tests) was 75% (1 year), 70% (5 years), and 69.2% (10 years). Six esophageal fistulas were observed secondary to transection. The Sugiura operation is an excellent complement to the therapeutic armamentarium used to treat portal hypertension, with low rebleeding and encephalopathy rates.
Orozco
H
H
Department of Surgery, Instituto Nacional de la Nutricion Salvador Zubiran, Mexico City, Mexico.
Mercado
M A
MA
Takahashi
T
T
Hernández-Ortiz
J
J
Capellán
J F
JF
Garcia-Tsao
G
G
D000293:Adolescent; D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods; D002648:Child; D004932:Esophageal and Gastric Varices / Q000601:surgery*; D004943:Esophagogastric Junction / Q000601:surgery; D004947:Esophagus / Q000601:surgery; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000601:surgery*; D006801:Humans; D006975:Hypertension, Portal / Q000601:surgery; D008107:Liver Diseases / Q000601:surgery; D008297:Male; D008800:Mexico / Q000453:epidemiology; D008875:Middle Aged; D011183:Postoperative Complications; D011708:Pylorus / Q000601:surgery; D012008:Recurrence; D013156:Splenectomy / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data; D013270:Stomach / Q000098:blood supply / Q000601:surgery; D015996:Survival Rate; D014628:Vagotomy / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data