Experience with the esophagogastric devascularization procedure.

Twenty-eight consecutive unselected patients were treated for esophageal varices by means of a modified Sugiura procedure between 1978 and 1985. In accordance with Child's classification, 59% were considered as class A, 11% as class B, and 30% as class C. The etiology of the cirrhosis included alcohol abuse (42%), hepatitis (33%), granulomatous disease (7%), and cryptogenic disease (18%). One patient had extrahepatic portal hypertension from unknown causes. The surgical treatment included esophageal and gastric devascularization in all cases. The average operative time was 4 1/2 hours. The average blood replacement during surgery was 8 units. The operative mortality was 32% (2/16 class A, 1/3 class B, and 6/9 class C). Morbidity occurred in 33% of the patients. Significant causes of morbidity and mortality were related to complications of the esophageal transection, which was omitted in the later series. Six of the eighteen patients who survived surgery died later, but only one death was due to presumed recurrent variceal hemorrhage. Significant bleeding occurred in four patients--two due to recurrent varices and two due to peptic ulcer disease. Encephalopathy, which was present preoperatively in two patients, is still manifest but is well controlled. Encephalopathy did not develop in any other patients. At present, the 12 surviving patients have stable liver function.