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Lu CL, Cao YJ, Cheng H, Pan YM, Bao SH, Xie M. Clinical factors that influence the outcome of selective devascularization in the treatment of portal hypertension. Oncotarget 2018; 7:50635-50642. [PMID: 27246983 PMCID: PMC5226609 DOI: 10.18632/oncotarget.9641] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 04/27/2016] [Indexed: 02/06/2023] Open
Abstract
There is a high incidence of death due to variceal hemorrhage in patients with portal hypertension. Factors to consider when choosing selective devascularization in the treatment of variceal hemorrhage remain a controversy. This study aims to generate the prevalent clinical risk factors that affect the outcomes of selective devascularization procedures. Elucidating these features may guide future treatment of esophageal varices in patients with portal hypertension. We retrospectively analyzed medical records of 455 patients who underwent selective devascularization procedures in our center. Patients were subject to splenectomy, selective devascularization with or without esophageal transection. The mode of surgery recurred in comparable rates in both the group with major complications postoperatively (high-risk group which consisted of 63 patients) or the group without major postoperative complications (low-risk group, 392). Risk factors that negatively influenced outcomes of surgery include severe symptoms (89% in high risk group and 71% in low risk group), large volume of blood loss in the hemorrhage before surgery (81% in high risk group and 16% in low risk group), sever liver cirrhosis (83% in high risk group and 67% in low risk group), previous endotherapy, prolonged prothrombin time, and poor liver function. Selective devascularization is a feasible option to treat variceal hemorrhage in patients with portal hypertension.
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Affiliation(s)
- Cheng-Lin Lu
- Department of General Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, Jiangsu Province, China
| | - Ya-Juan Cao
- Department of General Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, Jiangsu Province, China
| | - Hao Cheng
- Department of General Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, Jiangsu Province, China
| | - Yi-Ming Pan
- Department of General Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, Jiangsu Province, China
| | - Shan-Hua Bao
- Department of General Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, Jiangsu Province, China
| | - Min Xie
- Department of General Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, Jiangsu Province, China
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Diagnosis and treatment guidelines for aberrant portal hemodynamics: The Aberrant Portal Hemodynamics Study Group supported by the Ministry of Health, Labor and Welfare of Japan. Hepatol Res 2017; 47:373-386. [PMID: 28058764 DOI: 10.1111/hepr.12862] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 12/29/2016] [Accepted: 01/04/2017] [Indexed: 12/18/2022]
Abstract
Idiopathic portal hypertension (IPH), causing aberrant portal hemodynamics, is a disease with an as yet unidentified cause and no established treatment protocol. The Japanese research group on IPH in Japan was set up in 1975 by the Ministry of Health, Labor and Welfare. Extrahepatic portal obstruction and Budd-Chiari syndrome (BCS) have since been added to the group's research subjects. The aims of the research group are to accurately evaluate the current status of the three diseases in Japan, elucidate their etiology and pathogenesis, and develop new treatments. Due to the long-term efforts of the Japanese research group, aberrant portal hemodynamics has been investigated in a variety of aspects, from epidemiological and pathological studies to molecular biology analyses. As a result, it has been shown that there are abnormal genes in the liver, specific for IPH. In addition, pathological findings of BCS were internationally compared and the difference in findings between Japan and Europe (or North America) has been clarified. Furthermore, it was found that complication rates of hepatocellular carcinoma in BCS were higher in Japan. Based on the research, "Diagnosis and treatment of aberrant portal hemodynamics (2001)", including diagnostic criteria for aberrant portal hemodynamics, was published in 2001. In 2013, it was revised to "Diagnosis and treatment guidelines for aberrant portal hemodynamics (2013)" after the incorporation of diagnosis and treatment in accordance with its current status.
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Management of bleeding in extrahepatic portal venous obstruction. Int J Hepatol 2013; 2013:784842. [PMID: 23878740 PMCID: PMC3708426 DOI: 10.1155/2013/784842] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2012] [Accepted: 06/03/2013] [Indexed: 12/24/2022] Open
Abstract
Extrahepatic portal venous obstruction, although rare in the western world, is a common cause of major and life threatening upper gastrointestinal bleeding among the poor in developing countries. Patients have large spleens and stunted growth. The diagnosis is easily confirmed by Doppler ultrasonography. Endoscopy sclerotherapy is the best option for the control of acute variceal bleeding. For secondary prophylaxis of bleeding, the choice lies between repeated sclerotherapy and a portosystemic shunt. We believe that due consideration should be given to performing a splenectomy and a lienorenal shunt. Performed by experienced surgeons, it carries a low operative mortality of 1%, a rebleeding rate of about 10%, removes the large spleen, reverses hypersplenism, and is not followed by portosystemic encephalopathy. Most importantly, it is a onetime procedure particularly suited to those who have little access to blood transfusion and sophisticated medical facilities.
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Voros D, Polydorou A, Polymeneas G, Vassiliou I, Melemeni A, Chondrogiannis K, Arapoglou V, Fragulidis GP. 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. World J Surg 2012; 36:659-66. [PMID: 22270986 PMCID: PMC7102180 DOI: 10.1007/s00268-011-1418-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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.
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Affiliation(s)
- D. Voros
- 2nd Department of Surgery, Aretaieio Hospital, Medical School, University of Athens, 76 Vassilissis. Sophias Avenue, 11528 Athens, Greece
| | - A. Polydorou
- 2nd Department of Surgery, Aretaieio Hospital, Medical School, University of Athens, 76 Vassilissis. Sophias Avenue, 11528 Athens, Greece
| | - G. Polymeneas
- 2nd Department of Surgery, Aretaieio Hospital, Medical School, University of Athens, 76 Vassilissis. Sophias Avenue, 11528 Athens, Greece
| | - I. Vassiliou
- 2nd Department of Surgery, Aretaieio Hospital, Medical School, University of Athens, 76 Vassilissis. Sophias Avenue, 11528 Athens, Greece
| | - A. Melemeni
- 1st Department of Anesthesia, Aretaieio Hospital, Medical School, University of Athens, 11528 Athens, Greece
| | - K. Chondrogiannis
- 1st Department of Anesthesia, Aretaieio Hospital, Medical School, University of Athens, 11528 Athens, Greece
| | - V. Arapoglou
- 2nd Department of Surgery, Aretaieio Hospital, Medical School, University of Athens, 76 Vassilissis. Sophias Avenue, 11528 Athens, Greece
| | - G. P. Fragulidis
- 2nd Department of Surgery, Aretaieio Hospital, Medical School, University of Athens, 76 Vassilissis. Sophias Avenue, 11528 Athens, Greece
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Singhal D, Goyal N, Soin AS, Gupta S, Nundy S. What are the essential components of a transabdominal devascularization procedure for bleeding esophageal varices? World J Surg 2007; 31:861-2; author reply 863-4. [PMID: 17308847 DOI: 10.1007/s00268-007-0630-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Johnson M, Rajendran S, Balachandar TG, Kannan D, Jeswanth S, Ravichandran P, Surendran R. Transabdominal modified devascularization procedure with or without esophageal stapler transection--an operation adequate for effective control of a variceal bleed. Is esophageal stapler transection necessary? World J Surg 2006; 30:1507-18; discussion 1519. [PMID: 16865318 DOI: 10.1007/s00268-005-0754-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND In Japan, the original Sugiura procedure reported favorable results in non-cirrhotic patients but in the West, the modified Sugiura procedure is not widely accepted because of high rebleeding, morbidity, and mortality in cirrhotics. We retrospectively analyzed the efficacy of our modified Sugiura procedure i.e., devascularization with/without esophageal transection combined with salvage endotherapy and pharmacotherapy for control of a variceal bleed. MATERIALS AND METHODS Between January 1999 and December 2004, 912 patients with variceal bleeding were treated. Of these, 66 (7.2%) patients were subjected to surgery after failed endotherapy/propranolol. Among these 66 patients, 52 had transabdominal devascularization (16 emergency, 36 elective); 14 patients underwent devascularization with esophageal stapler transection (group I), and 38 patients had devascularization without esophageal stapler transection (group II). Another 14 patients underwent elective end-to-side proximal splenorenal shunt surgery. RESULTS Postoperative mortality was 7.1% in group I, 10.5% in group II (P>0.05). Mortality for emergency surgery was 31.2% (5/16) but there were no deaths in the elective surgery group. Overall morbidity was 57.1% in group I and 21.0% in group II (P<0.05). The rates of variceal rebleeding were 7.1% and 7.8%; residual varices were 30.7% and 32.3%; recurrent varices were 7.6% and 5.8% following the group I and group II procedures, respectively, over a mean follow-up period of 39.9 (7-2) months. Esophageal transection-related morbidity (leak, stricture, and bleeding) was 21.4% (3/14) in group I. CONCLUSIONS Devascularization without esophageal stapler transection is a safe and effective procedure for adequate (urgent and long-term) control of variceal bleeding with similar results and less morbidity when compared to devascularization with esophageal transection in cirrhotic patients, as well as non-cirrhotic patients.
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Affiliation(s)
- M Johnson
- Department of Surgical Gastroenterology, Center for G.I. Bleed & Division of Hepato Biliary Pancreatic Diseases, Government Stanley Medical College Hospital, Old Jail Road, Royapuram, Chennai, 600 001, Tamilnadu, India
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Qazi SA, Khalid K, Hameed AMA, Al-Wahabi K, Galul R, Al-Salamah SM. Transabdominal gastro-esophageal devascularization and esophageal transection for bleeding esophageal varices after failed injection sclerotherapy: long-term follow-up report. World J Surg 2006; 30:1329-37. [PMID: 16633704 DOI: 10.1007/s00268-005-0372-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Management of continued bleeding from esophageal varices despite adequate injection sclerotherapy remains one of the medical and surgical dilemmas. Transabdominal gastroesophageal devascularization and esophageal transection (TGDET) is considered an effective and safe procedure for such patients. AIM This study aimed at presenting continued evaluation of TGDET. Various problems influencing the early outcome are discussed, and long-term outcome is analyzed. DESIGN This was a prospective clinical descriptive study. METHODS Prospective data was collected on 142 consecutive patients managed by one group of surgeons over a 5 year-period and 15 years follow-up after failed injection sclerotherapy for variceal bleeding. Evaluation was made in terms of effectiveness in controlling the acute bleeding, postoperative morbidity and mortality, recurrent bleeding, encephalopathy, and long-term survival. RESULTS There were 133 men and 9 women. Mean age was 41.8 years. Etiology of portal hypertension was bilharziasis in 54.9% and posthepatitic in 14.8%. Child-Pugh grading on admission was A: 47.2%, B: 28.8%, and C: 14%. Hemorrhage was controlled in all cases. Clinical leak was observed in 5.6%, portal vein thrombosis in 6.3%, and staple line erosion in 2.1% of cases. No patient developed encephalopathy. In-hospital mortality was 12.7%. Complete eradication of varices was observed in 70.6% patients. Recurrent variceal bleeding was noticed in 6.9% of cases. Actuarial 15-year survival for Child-Pugh A patients was 44%, B was 22.5%, and none for C. CONCLUSION TGDET remains a safe and effective procedure after failure of sclerotherapy when other alternatives are either not indicated or not available.
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Affiliation(s)
- Shabir Ahmad Qazi
- Department of General Surgery, Riyadh Medical Complex, Riyadh, Kingdom of Saudi Arabia
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Hsieh JS, Jan CM, Lu CY, Chen FM, Wang JY, Huang TJ. Preoperative Evaluation of Endoscopic Ultrasonography and Portography in Selecting Devascularization Surgery for Esophagogastric Varices. Am Surg 2005. [DOI: 10.1177/000313480507100515] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study assesses the role of endoscopic ultrasonography (EUS) and portography in selection of mode of devascularization surgery for esophagogastric varices (EGV) in patients with portal hypertension and reports our experience in the treatment of EGV with modified devascularization surgery. Forty-two cirrhotic patients with EGV were treated with devascularization surgery for variceal hemorrhage. Preoperatively, percutaneous transhepatic portography (PTP) and EUS were used as the guiding mode for therapy of EGV. In addition to devascularization and splenectomy, esophageal transection (ET) was performed in 26 patients with upward-flow varices (UFV), whereas 16 patients with downward-flow varices (DFV) underwent proximal gastrectomy instead of ET. In both UFV and DFV groups, grade II of intramural varices and extramural collaterals were most commonly observed on EUS imaging. There was no significant difference of EUS grading between these two groups ( P > 0.05). The incidence of postoperative complications, mortality, and recurrent varices were not significantly different between these two groups. The overall 5-year survival rate for UFV group was 69.2 per cent, whereas that for the DFV group was 68.7 per cent ( P > 0.05). Our study shows that devascularization surgery is highly effective for the prevention of recurrent bleeding from EGV, and it provides an alternative treatment modality. Combined PTP and EUS are very helpful in determining adequate modalities of devascularization surgery.
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Affiliation(s)
- Jan-Sing Hsieh
- Departments of Surgery, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chang-Ming Jan
- Departments of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chien-Yu Lu
- Departments of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Fang-Ming Chen
- Departments of Surgery, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jaw-Yuan Wang
- Departments of Surgery, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Tsung-Jen Huang
- Departments of Surgery, Kaohsiung Medical University, Kaohsiung, Taiwan
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Selzner M, Tuttle-Newhall JE, Dahm F, Suhocki P, Clavien PA. Current indication of a modified Sugiura procedure in the management of variceal bleeding. J Am Coll Surg 2001; 193:166-73. [PMID: 11491447 DOI: 10.1016/s1072-7515(01)00937-1] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND The role of gastroesophageal devascularization (Sugiura-rype procedures) for the treatment of variceal bleeding remains controversial. Although Japanese series reported favorable longterm results, the technique has nor been widely accepted in the Western Hemisphere because of a high postoperative morbidity and mortality. The reasons for the different outcomes are unclear. In a multidisciplinary team approach we developed a therapeutic algorithm for patients with recurrent variceal bleeding. STUDY DESIGN The Sugiura procedure was offered only to patients with well-preserved liver function (Child A or Child B cirrhosis without chronic ascites) who were not candidates for distal splenorenal shunt, transhepatic porto-systemic shunt, or liver transplantation. RESULTS Fifteen patients with recurrent variceal bleeding underwent a modified Sugiura procedure between September 1994 and September 1997. All but one patient (operative mortality 7%) are alive after a median followup of 4 years. Recurrent variceal bleeding developed in one patient; esophageal strictures, which were successfully treated by endoscopic dilatation, developed in three patients; and one patient experienced mild encephalopathy. Major complications were noted only in patients with impaired liver function (Child B cirrhosis) or when the modified Sugiura was performed in an emergency setting. The presence of cirrhosis or the cause of portal hypertension had no significant impact on the complication rate. CONCLUSIONS This series was performed during the last decade when all modern therapeutic options for variceal bleeding were available. Our results indicate that the modified Sugiura procedure is an effective rescue therapy in patients who are not candidates for selective shunts, transhepatic porto-systemic shunt, or transplantation. Emergency settings and decreased liver function are associated with an increased morbidity.
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Affiliation(s)
- M Selzner
- Department of Visceral Surgery and Transplantation, Universitätsspital, Zürich, Switzerland
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Shah SR. The difficulties in carrying out this study comparing three established modalities of preventing recurrent variceal hemorrhage in patients with portal hypertension. Ann Surg 2001; 234:263-5. [PMID: 11505074 PMCID: PMC1422015 DOI: 10.1097/00000658-200108000-00019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Shah SR. Re: Orozco et al. A comparative study of the elective treatment of variceal hemorrhage with beta-blockers, transendoscopic sclerotherapy and surgery. A prospective, controlled, and randomized trial during 10 years. Ann Surg 2000; 232:216-9. Ann Surg 2001; 234:133-4. [PMID: 11420496 PMCID: PMC1421962 DOI: 10.1097/00000658-200107000-00028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Iwase H, Maeda O, Shimada M, Tsuzuki T, Peek RM, Nishio Y, Ando T, Ina K, Kusugami K. Endoscopic ablation with cyanoacrylate glue for isolated gastric variceal bleeding. Gastrointest Endosc 2001; 53:585-92. [PMID: 11323583 DOI: 10.1067/mge.2001.113921] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Endoscopic ablation with cyanoacrylate glue may achieve gastric variceal obliteration. A prospective evaluation of its therapeutic effects on bleeding gastric varices was conducted, focusing on endoscopic features. METHODS Thirty-seven patients with bleeding gastric varices underwent endoscopic ablation with cyanoacrylate. RESULTS Patients with localized-type gastric varices (n = 14) had a better clinical course in terms of recurrent bleeding, variceal eradication, and survival than those with diffuse-type gastric varices (n = 23) after endoscopic ablation with cyanoacrylate. These clinical effects were related to the vascular anatomy of the gastric varices as determined by varicography and 3-dimensional CT. Type 1 vascular anatomy (one varicose vessel without noticeable ramifications) was much more common (86%) in localized-type gastric varices, whereas type 2 vascular anatomy (multiple varicose vessels with complex connecting ramifications) was found almost exclusively (91%) in diffuse-type gastric varices. CONCLUSIONS Endoscopic ablation with cyanoacrylate is an effective and safe procedure for patients with bleeding gastric varices. Determination of variceal anatomy may be useful for improving treatment strategies for such patients.
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Affiliation(s)
- H Iwase
- Department of Gastroenterology, Nagoya National Hospital, the First Department of Internal Medicine, Nagoya University School of Medicine, Nagoya, Japan
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Abstract
Endoscopic therapy and in particular endoscopic variceal banding ligation, in experienced hands, is the treatment of choice for acute variceal bleeding which remains a major cause of death in patients with cirrhosis and portal hypertension. Pharmacological therapy with Glypressin or somatostatin can be useful to gain time when the endoscopic expertise is not available or to help to obtain a clearer endoscopic view. Transjugular intrahepatic porto-systemic stent shunt is currently used for endoscopic failures, producing similar results with the surgical portacaval shunts. Which one of the two should be preferred, since they both work best in relatively compensated patients, should be a balance between the available surgical and radiological expertise, the urgency of the situation and the expected course of the disease.
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Affiliation(s)
- P Vlavianos
- Department of Gastroenterology, Chelsea and Westminster Hospital, 369 Fulham Road, London, SW10 9NH, UK
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Sharma D, Agrawal S, Saxena A, Raina VK. A modified technique of devascularization for surgical management of portal hypertension in children. Trop Doct 2001; 31:93-5. [PMID: 11321283 DOI: 10.1177/004947550103100213] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In developing countries surgery is indicated in patients with portal hypertension for a variety of reasons. This study prospectively evaluates a modified technique of devascularization for secondary prophylaxis of variceal bleeding in patients with portal hypertension of different aetiologies. Transabdominal extensive oesophagogastric devascularization combined with transmural ligation of oesophageal and gastric varices was performed in 16 paediatric patients (nine with extrahepatic portal venous obstruction, and seven with non-cirrhotic portal fibrosis) in an elective setting. The Sugiura devascularization procedure was modified to minimize the operating time and to avoid the problems associated with oesophageal transection and anastomosis. The operative mortality rate as well as the oesophageal leak rate was zero. One patient developed an oesophageal stricture. During a 12-month follow-up, patients were seen with residual varices (2), recurrent varices (3) and rebleeding (1). Porto-systemic encephalopathy was seen in one patient only. This technique is a simple, straightforward, safe and effective modification of the Sugiura procedure in controlling bleeding, providing good quality of life with minimal porto-systemic encephalopathy.
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Affiliation(s)
- D Sharma
- Department of Surgery, NSCB Government Medical College, Jabalpur, India.
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Reed DN, Vitale GC. Interventional endoscopic retrograde cholangiopancreatography and endoscopic surgery. Surg Clin North Am 2000; 80:1171-201. [PMID: 10987030 DOI: 10.1016/s0039-6109(05)70219-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Interventional endoscopic techniques have been indespensible in almost every area of modern surgery. As surgeons, we need to continue to advance our skills in these areas if we expect to continue to be involved in these aspects of patient care.
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Affiliation(s)
- D N Reed
- Department of Surgery, University of Louisville School of Medicine, Kentucky, USA
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