The Sugiura procedure: a prospective experience.

BACKGROUND

The Sugiura procedure, which includes esogastric devascularization, splenectomy, and esophageal transection, aims to suppress esophageal varices without exposing the patient to hepatic encephalopathy, because the operation does not alter hepatic blood flow.

METHODS

From May 1978 to March 1989, 39 patients (79% with cirrhosis) with previous variceal bleeding underwent an elective Sugiura procedure. Thirteen of them (33%) had recurrent bleeding despite medical therapy.

RESULTS

There were neither operative deaths nor intraoperative complications. Eighteen patients (46%) had 19 postoperative complications, which were severe in 7 cases. During the second postoperative month, 68% of the patients had no visible varices at endoscopy. There was no alteration of liver function at 1 year after operation. Ninety-five percent, 85% and 76% of patients were free of recurrent variceal bleeding at 1, 3, and 5 years, respectively. None of the patients had chronic encephalopathy. One-, 3-, and 5-year survival rates were 95%, 70%, and 70%, respectively. Survival curves were not different in patients with and without cirrhosis.

CONCLUSIONS

The Sugiura procedure carries a low operative risk and results in good prevention of recurrent variceal bleeding. Moreover, the liver function remains stable after operation and there is no significant risk of hepatic encephalopathy. This procedure should be reserved for failure of medical therapy.