Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
World Journal of Surgery
Published in: World Journal of Surgery 3/2012

01-03-2012

Long-term Results with the Modified Sugiura Procedure for the Management of Variceal Bleeding: Standing the Test of Time in the Treatment of Bleeding Esophageal Varices

Authors: D. Voros, A. Polydorou, G. Polymeneas, I. Vassiliou, A. Melemeni, K. Chondrogiannis, V. Arapoglou, G. P. Fragulidis

Published in: World Journal of Surgery | Issue 3/2012

Login to get access

Abstract

Background

The surgical approaches to the treatment of bleeding esophageal varices in cirrhotic patients have been reduced since the clinical development of endoscopic sclerotherapy, transjugular intrahepatic portosystemic shunt (TIPS), and liver transplantation. However, when acute sclerotherapy fails, and in cases where no further treatment is accessible, emergency surgery may be life saving. In the present study we retrospectively analyzed the results of the modified Sugiura procedure, performed as emergency and semi-elective treatment in the patient with bleeding esophageal varices.

Methods

Ninety patients with cirrhosis and portal hypertension were managed in our department for variceal esophageal bleeding between January 1985 and December 1992. The modified Sugiura procedure was performed in 46 patients on an emergency (25 patients) or semi-elective (21 patients) basis. Liver cirrhosis stage according to Child classification was A in 4 patients, B in 16 patients, and C in 26 patients.

Results

Acute bleeding was controlled in all patients. Postoperative mortality was 23.9% (11 of 46 patients). The mortality rate was 34.6% in Child class C patients (9 of 26 patients), and 12.5% in Child class B patients (2 of 16 patients). Twenty-four patients had long-term follow-up extending from 14 months to 22 years (mean 83.1 months). Ten of 24 patients (41.6%) did not develop rebleeding for 5–22 years (mean 10.3 years). Overall 5-year survival in these 24 patients was 62.5%.

Conclusions

The modified Sugiura procedure remains an effective rescue therapy for patients with bleeding esophageal varices when alternative treatments fail or are not indicated. Moreover, it can be a life-saving procedure in patients with anatomy unsuitable for shunt surgery or for patients treated in nonspecialized centers where surgical expertise for a shunt operation is not available.
Literature
1.
Wolff M, Hirner A (2003) Current state of portosystemic shunt surgery. Langenbecks Arch Surg 388:141–149PubMedCrossRef
2.
Bosch J, Berzigotti A, Garcia-Pagan JC et al (2008) The management of portal hypertension: rational basis, available treatments and future options. J Hepatol 48(Suppl 1):S68–S92PubMedCrossRef
3.
4.
Wright AS, Rikkers LF (2005) Current management of portal hypertension. J Gastrointest Surg 9:992–1005PubMedCrossRef
5.
Burroughs AK, Vangeli M (2002) Transjugular intrahepatic portosystemic shunt versus endoscopic therapy: randomized trials for secondary prophylaxis of variceal bleeding: an updated meta-analysis. Scand J Gastroenterol 37:249–252PubMedCrossRef
6.
Selzner M, Tuttle-Newhall JE et al (2001) Current indication of a modified Sugiura procedure in the management of variceal bleeding. J Am Coll Surg 193:166–173PubMedCrossRef
7.
Dagenais M, Langer B, Taylor BR et al (1994) Experience with radical esophagogastric devascularization procedures (Sugiura) for variceal bleeding outside Japan. World J Surg 18:222–228. doi:10.​1007/​BF00294405 PubMedCrossRef
8.
Voros D, Androulakis G, Mallas E et al (1993) Immediate results of operations for esophageal varices. Hell J Gastroenterol 6:261–266
9.
Voros D, Karapanos K, Kyriazi M et al (2007) Long-term outcome of a modified Sugiura procedure for bleeding esophageal varices. ISW 2007 conference abstract ID: 113
10.
Grace ND (1992) Prevention of initial variceal hemorrhage. Gastroenterol Clin N Am 21:149–161
11.
12.
Burnett DA, Rikkers LF (1990) Nonoperative emergency treatment of variceal hemorrhage. Surg Clin N Am 70:291–306PubMed
13.
D’Amico G, Pagliaro L, Bosch J (1995) The treatment of portal hypertension: a meta-analytic review. Hepatology 22:332–354PubMed
14.
de Franchis R, Primignani M (1999) Endoscopic treatments for portal hypertension. Semin Liver Dis 19:439–455PubMedCrossRef
15.
Henderson JM, Nagle A, Curtas S et al (2000) Surgical shunts and TIPS for variceal decompression in the 1990 s. Surgery 128:540–547PubMedCrossRef
16.
17.
Orozco H, Juarez F, Uribe M et al (1986) Sugiura procedure outside Japan. The Mexican experience. Am J Surg 152:539–542PubMedCrossRef
18.
Gouge TH, Ranson JH (1986) Esophageal transection and paraesophagogastric devascularization for bleeding esophageal varices. Am J Surg 151:47–54PubMedCrossRef
19.
Mercado MA, Orozco H, Vasquez M et al (1998) Comparative study of 2 variants of a modified esophageal transection in the Sugiura–Futagawa operation. Arch Surg 133:1046–1049PubMedCrossRef
20.
Jin G, Rikkers LF (1996) Transabdominal esophagogastric devascularization as treatment for variceal hemorrhage. Surgery 120:641–647 (discussion 647–649)PubMedCrossRef
21.
Walker RM (1964) Esophageal transection for bleeding varices. Surg Gynecol Obstet 118:323PubMed
22.
Johnston GW (1977) Treatment of bleeding varices by oesophageal transection with the SPTU gun. Ann R Coll Surg Engl 59:404–408PubMed
23.
Burroughs AK, Hamilton G, Phillips A et al (1989) A comparison of sclerotherapy with staple transection of the esophagus for the emergency control of bleeding from esophageal varices. N Engl J Med 321:857–862PubMedCrossRef
24.
25.
Sugiura M, Futagawa S (1984) Esophageal transection with paraesophagogastric devascularizations (the Sugiura procedure) in the treatment of esophageal varices. World J Surg 673–679. doi:10.​1007/​BF01655762
26.
Barbot DJ, Rosato EF (1987) Experience with the esophagogastric devascularization procedure. Surgery 101:685–690PubMed
27.
Weese JL, Starling JR, Yale CE (1984) Control of bleeding esophageal varices by transabdominal esophageal transection, gastric devascularization, and splenectomy. Surg Gastroenterol 3:31–36PubMed
28.
Ginsberg RJ, Waters PF, Zeldin RA et al (1982) A modified Sugiura procedure. Ann Thorac Surg 34:258–264PubMedCrossRef
29.
Cello JP, Crass R, Trunkey DD (1982) Endoscopic sclerotherapy versus esophageal transection of Child class C patients with variceal hemorrhage. Comparison with results of portacaval shunt: preliminary report. Surgery 91:333–338PubMed
30.
Hosking SW, Johnson AG (1987) What happens to esophageal varices after transection and devascularization? Surgery 101:531–534PubMed
31.
Qazi SA, Khalid K, Hameed AM et al (2006) Transabdominal gastro-esophageal devascularization and esophageal transection for bleeding esophageal varices after failed injection sclerotherapy: long-term follow-up report. World J Surg 30:1329–1337. doi:10.​1007/​s00268-005-0372-7 PubMedCrossRef
32.
Spence RAJ, Johnston GW (1985) Results in 100 consecutive patients with stapled esophageal transaction for varices. Surg Gynecol Obstet 160:323–329PubMed
33.
Langer BF, Greig PD, Taylor BR (1990) Emergency surgical treatment of variceal hemorrhage. Surg Clin N Am 70:307–311PubMed
34.
Koyanagi N, Iso Y, Higashi H et al (1988) Recurrence of varices after oesophageal transection: intra-operative and postoperative assessment by endoscopy. Br J Surg 75:9–11PubMedCrossRef
35.
Johnson M, Rajendran S, Balachandar TG et al (2006) Transabdominal modified devascularization procedure with or without esophageal stapler transaction—an operation adequate for effective control of a variceal bleed. Is esophageal stapler transection necessary? World J Surg 30:1507–1518. doi:10.​1007/​s00268-005-0754-x (discussion 1519)PubMedCrossRef
36.
Comar KM, Sanyal AJ (2003) Portal hypertensive bleeding. Gastroenterol Clin N Am 32:1079–1105CrossRef
37.
Idezuki Y, Sanjyo K (1989) Twenty-five-year experiences with esophageal transection for esophageal varices. J Thorac Cardiovasc Surg 98:876–883PubMed
38.
Mathur SK, Shah SR, Soonawala ZF et al (1997) Transabdominal extensive oesophagogastric devascularization with gastro-oesophageal stapling in the management of acute variceal bleeding. Br J Surg 84:413–417PubMedCrossRef
39.
Goyal N, Singhal D, Gupta S et al (2007) Transabdominal gastroesophageal devascularization without transection for bleeding varices: results and indicators of prognosis. J Gastroenterol Hepatol 22:47–50PubMedCrossRef
40.
Chaudhary A, Aranya RC (1991) Devascularization following endoscopic sclerotherapy of oesophageal varices: dangers and difficulties. Br J Surg 78:1249–1251PubMedCrossRef
41.
Klempnaue J, Schrem H (2001) Review: surgical shunts and encephalopathy. Metab Brain Dis 16:21–25PubMedCrossRef
42.
Chalasani N, Clark WS, Martin LG et al (2000) Determinants of mortality in patients with advanced cirrhosis after transjugular intrahepatic portosystemic shunting. Gastroenterology 118:138–144PubMedCrossRef
43.
LaBerge JM, Sombers KA, Lake JR et al (1995) Two-year outcome following transjugular intrahepatic portosystemic shunt for variceal bleeding: results in 90 patients. Gastroenterology 108:1143–1151PubMedCrossRef
44.
45.
Sanyal AJ, Freedman AM, Luketic VA et al (1996) Transjugular intrahepatic portosystemic shunts for patients with active variceal hemorrhage unresponsive to sclerotherapy. Gastroenterology 111:138–146PubMedCrossRef
46.
Orloff MJ, Isenberg JI, Wheeler HO et al (2010) Liver transplantation in a randomized controlled trial of emergency treatment of acutely bleeding esophageal varices in cirrhosis. Transplant Proc 42:4101–4108PubMedCrossRef
47.
Terblanche J (2002) The management of portal hypertension: controversies. J Gastroenterol Hepatol 17(Suppl):S439–S440PubMedCrossRef
Metadata
Title
Long-term Results with the Modified Sugiura Procedure for the Management of Variceal Bleeding: Standing the Test of Time in the Treatment of Bleeding Esophageal Varices
Authors
D. Voros
A. Polydorou
G. Polymeneas
I. Vassiliou
A. Melemeni
K. Chondrogiannis
V. Arapoglou
G. P. Fragulidis
Publication date
01-03-2012
Publisher
Springer-Verlag
Published in
World Journal of Surgery / Issue 3/2012
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-011-1418-7

Other articles of this Issue 3/2012

World Journal of Surgery 3/2012 Go to the issue

Letter

The Best Therapy for Pilonidal Disease: Which Management for Which Type?

OriginalPaper

Validation of the “Perrier” Parathyroid Adenoma Location Nomenclature

OriginalPaper

Enterocutaneous Fistulas and a Hostile Abdomen: Reoperative Surgical Approaches

OriginalPaper

Primary Surgery in Rural Areas of Southern Sudan

OriginalPaper

Trauma and Burn Education: A Global Survey

OriginalPaper

Correlation Between the Pretherapeutic Neutrophil to Lymphocyte Ratio and the Pathologic Response to Neoadjuvant Chemotherapy in Patients With Advanced Esophageal Cancer