Results of a Modified Sugiuras Devascularisation in theManagement of Unshuntable Portal Hypertension

摘要

The results of a modified Sugiura devascularisation procedure were assessed in 14 patients with thrombosis of the portal and splenic vein requiring surgery for variceal hemorrhage, with no vein suitable for orthodox shunt surgery. The venous anatomy was determined by ultrasonography with Doppler studies and portovenography. Liver biochemistry as well as liver architecture on histopathology was normal in all. The surgery was elective in 9 cases for documented bleed from diffuse fundal gastric varices (FGV) and emergency in 5 cases, 3 having bleeding FGV and 2 for failure of emergency esophageal variceal sclerotherapy. All were subjected to a transabdominal extensive devascularisation of the upper two third of the stomach and lower 7–10cm of the esophagus. Stapled esophageal transection (n=11) or esophageal variceal under-running(n=1) was performed in all with esophagealvarices. FGV were underrun. Follow up endoscopieswere done six monthly. There were 9 males and 5females with a mean age of 17.2 years (SD 12.8).There was no operative mortality. Acute varicealbleeding was controlled in all patients. Over a meanfollow up of 38 months, all but one remain free ofrecurrent bleeding. We conclude that a modifiedSugiura devascularisation procedure is effective inthe immediate and medium term control of varicealbleeding in patients with “unshuntable” portalhypertension.