November 1977

Further Evaluation of the Sugiura Procedure in the Treatment of Esophageal Varices

Author Affiliations

From the Second Department of Surgery, Faculty of Medicine, University of Tokyo, Tokyo.

Arch Surg. 1977;112(11):1317-1321. doi:10.1001/archsurg.1977.01370110051005

• A total of 276 patients had an esophageal transection with paraesophagogastric devascularization (the Sugiura procedure) for esophageal varices from 1967 to the present; 60 procedures were prophylactic, 164 were elective, and 52 were emergency procedures. The age distribution was from 9 months to 74 years. The origin was cirrhosis in 191 patients, fibrosis in 59, extrahepatic portal vein occlusion in 18, hepatoma in five, schistosomiasis in one, Budd-Chiari syndrome in one, and carcinoma of the pancreas in one patient. The mortality within one month of operation was 5.0% in prophylactic cases, 1.8% in elective cases, and 11.5% in emergency cases (mean, 4.3%). The actuarial seven-year survival rate was 83%. There was an obvious positive correlation between survival rate and stage of the disease. Ninety-five percent of class A (Child's classification) and 87% of class B are alive, but only 59% of class C patients are alive at the present. Six patients had recurrences of varices for a recurrence rate of 2.3%, of whom four had esophageal bleeding. It may be that recurrence of varices occurred due to incomplete devascularization of the esophagus at the diaphragm because of the necessity of two-stage operations in poor-risk patients. All survivors are free from encephalopathy. The present study reconfirmed that our method is safe and effective in controlling esophageal variceal bleeding without compromising hepatic function.

(Arch Surg 112:1317-1321, 1977)