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Current indication of a modified Sugiura procedure in the management of variceal bleeding.

Publication ,  Journal Article
Selzner, M; Tuttle-Newhall, JE; Dahm, F; Suhocki, P; Clavien, PA
Published in: J Am Coll Surg
August 2001

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.

Duke Scholars

Published In

J Am Coll Surg

DOI

ISSN

1072-7515

Publication Date

August 2001

Volume

193

Issue

2

Start / End Page

166 / 173

Location

United States

Related Subject Headings

  • Vascular Surgical Procedures
  • Treatment Outcome
  • Treatment Failure
  • Surgery
  • Severity of Illness Index
  • Recurrence
  • Middle Aged
  • Male
  • Humans
  • Gastrointestinal Hemorrhage
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Selzner, M., Tuttle-Newhall, J. E., Dahm, F., Suhocki, P., & Clavien, P. A. (2001). Current indication of a modified Sugiura procedure in the management of variceal bleeding. J Am Coll Surg, 193(2), 166–173. https://doi.org/10.1016/s1072-7515(01)00937-1
Selzner, M., J. E. Tuttle-Newhall, F. Dahm, P. Suhocki, and P. A. Clavien. “Current indication of a modified Sugiura procedure in the management of variceal bleeding.J Am Coll Surg 193, no. 2 (August 2001): 166–73. https://doi.org/10.1016/s1072-7515(01)00937-1.
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 Aug;193(2):166–73.
Selzner, M., et al. “Current indication of a modified Sugiura procedure in the management of variceal bleeding.J Am Coll Surg, vol. 193, no. 2, Aug. 2001, pp. 166–73. Pubmed, doi:10.1016/s1072-7515(01)00937-1.
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 Aug;193(2):166–173.
Journal cover image

Published In

J Am Coll Surg

DOI

ISSN

1072-7515

Publication Date

August 2001

Volume

193

Issue

2

Start / End Page

166 / 173

Location

United States

Related Subject Headings

  • Vascular Surgical Procedures
  • Treatment Outcome
  • Treatment Failure
  • Surgery
  • Severity of Illness Index
  • Recurrence
  • Middle Aged
  • Male
  • Humans
  • Gastrointestinal Hemorrhage