Modified Sugiura procedure for the management of 160 cirrhotic patients with portal hypertension.
BACKGROUND
Portal hypertension is a common disease with a high mortality and serious effect on the life quality of patients. Presently, shunt and disconnection are commonly used for surgical treatment of portal hypertension. The aim of this study was conducted to analyze the results of a modified Sugiura procedure for the management of 160 cirrhotic patients with portal hypertension.


METHODS
The results of a modified Sugiura procedure for the treatment of 160 cirrhotic patients with portal hypertension from January 1991 to July 2002 were retrospectively analyzed.


RESULTS
The operative mortality for the procedure was zero. Postoperative intra-abdominal bleeding was noted in 2 patients, drowned lung in 1, pneumonia in 1, and splenic venous thrombosis in 4. Of the 160 patients, 157 (98%) were followed up from 6 months to 11.5 years. Of the 157 patients, only one died of hepatic coma 6 years after operation, and 3 of rebleeding. The absolute and relative survival rates were 97.5%(156/160) and 99%(159/160), respectively. The absolute and relative occurrence rates of hepatic coma were 2.5%(4/160) and 0.6%(1/157), respectively. The absolute and relative occurrence rates of rebleeding were 3.8%(6/160) and 1.9%(3/157), respectively. In 96 of 116 Child B patients (82.8%), liver function improved from preoperative class B to A 3 months after operation. Sixty-five patients were subjected to gastroscopy and 22 patients, esophageal barium photography 6 months after operation. Gastro-esophageal varices disappeared in 56 patients (64.4%, 56/87), obviously improved in 30 (34.5%, 30/87), and unchanged in 1 (1.2%, 1/87). The occurrence rate of portal hypertensive gastropathy (PHG) was 13.9%(9/65).


CONCLUSIONS
Our results showed that the modified Sugiura procedure is effective in the treatment of portal hypertension, with a low rate of operative complication, bleeding recurrence, and hepatic coma.
Department of Second Biliary Surgery, Eastern Hepatobiliary Hospital, Shanghai 200438, China. yougangma@tom.com
You-Gang
YG
Ma
Xiao-Song
XS
Li
Jun
J
Zhao
Han
H
Chen
Meng-Chao
MC
Wu
D000328:Adult; D000368:Aged; D004947:Esophagus / Q000098:blood supply; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006975:Hypertension, Portal / Q000401:mortality / Q000601:surgery*; D008103:Liver Cirrhosis / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D013156:Splenectomy; D013270:Stomach / Q000098:blood supply; D014656:Vascular Surgical Procedures / Q000379:methods* / Q000401:mortality