Comparison of a modified Sugiura procedure with portal systemic shunt for prevention of recurrent variceal bleeding in cirrhosis.
BACKGROUND
There is no agreement on the management of patients with cirrhosis and recurrent variceal bleeding after failure of medical or endoscopic treatments or both. Portal systemic shunts are highly effective in preventing rebleeding but are associated with a high incidence of chronic encephalopathy. This study compared the results of a slightly modified Sugiura procedure (esophageal transection plus esophagogastric devascularization plus splenectomy) with those of nonselective portal systemic shunts in patients with previous variceal bleeding.


METHODS
Fifty-four patients were included in this randomized controlled study between January 1984 and April 1989. The major end point was chronic encephalopathy. Secondary end points were recurrent variceal bleeding, survival, ascites, and hepatocellular carcinoma.


RESULTS
Twenty-seven patients were assigned to each group. The rate of chronic encephalopathy was significantly (p = 0.002) lower after modified Sugiura procedure than after portal systemic shunt. Recurrent variceal bleeding was more frequent after modified Sugiura procedure than after portal systemic shunt, but the difference is not significant. One-, two-, and three-year survival rates were 93%, 81%, and 67%, respectively, in the modified Sugiura group and 78%, 66%, and 39%, respectively, in the portal systemic shunt group (p = 0.044).


CONCLUSIONS
These results suggest that the modified Sugiura procedure is better overall than the nonselective portal systemic shunt in the management of patients with cirrhosis and recurrent variceal bleeding. Although the rebleeding rate is higher after the modified Sugiura procedure, this does not seem to affect mortality in these patients.
Borgonovo
G
G
Department of Surgery, Hôpital Antoine Béclère, Université Paris-Sud, Clamart, France.
Costantini
M
M
Grange
D
D
Vons
C
C
Smadja
C
C
Franco
D
D
D006528:Carcinoma, Hepatocellular / Q000401:mortality; D002423:Cause of Death; D004932:Esophageal and Gastric Varices / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000401:mortality; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D017093:Liver Failure / Q000401:mortality; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011170:Portasystemic Shunt, Surgical / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D011183:Postoperative Complications / Q000453:epidemiology / Q000401:mortality; D012008:Recurrence; D015996:Survival Rate; D013997:Time Factors; D017211:Treatment Failure