title: Transabdominal gastroesophageal devascularization without esophageal transection for emergency treatment of variceal hemorrhage.
abstract: BACKGROUND
  The Suguira procedure is an effective non-shunting operation to treat life-threatening hemorrhage from esophageal or gastric varices. The goal of esophageal transection is interruption of submucosal varices, but this leads to high morbidity and mortality rates from esophageal fistulization.
  
  
  OBJECTIVE
  To evaluate a variant of this procedure in which the esophagus is not transected, but the varices are underrun from outside the lumen.
  
  
  METHODS
  During the last four and a half years, we performed this modified gastroesophageal devascularization with or without splenectomy in 18 patients as emergency treatment of bleeding esophageal and gastric varices. The data were analyzed retrospectively.
  
  
  RESULTS
  Bleeding was controlled in all patients. Three patients with Child's class C disease undergoing emergency surgery died during the early postoperative period. Rebleeding rate was 17% (3 patients). The overall survival was 72.2% (13 of 18). No patient had encephalopathy over a mean follow up of 30 months.
  
  
  CONCLUSIONS
  Gastroesophageal devascularization with variceal under-running without esophageal transection is an effective and safe alternative to shunt surgery in the emergency situation.
authors.affiliation: Department of Surgery, Christian Medical College and Hospital, Ludhiana, Punjab.
authors.forename: R
authors.initials: R
authors.lastname: Kapoor
authors.forename: S
authors.initials: S
authors.lastname: Agarwal
authors.forename: G
authors.initials: G
authors.lastname: Pawar
authors.forename: M
authors.initials: M
authors.lastname: Verghese
mesh_terms: D004638:Emergency Treatment; D004932:Esophageal and Gastric Varices / Q000601:surgery*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies