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Transabdominal Modified Devascularization Procedure with or without Esophageal Stapler Transection—An Operation Adequate for Effective Control of a Variceal Bleed. Is Esophageal Stapler Transection Necessary?

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Abstract

Background

In Japan, the original Sugiura procedure reported favorable results in non-cirrhotic patients but in the West, the modified Sugiura procedure is not widely accepted because of high rebleeding, morbidity, and mortality in cirrhotics. We retrospectively analyzed the efficacy of our modified Sugiura procedure i.e., devascularization with/without esophageal transection combined with salvage endotherapy and pharmacotherapy for control of a variceal bleed.

Materials and Methods

Between January 1999 and December 2004, 912 patients with variceal bleeding were treated. Of these, 66 (7.2%) patients were subjected to surgery after failed endotherapy/propranolol. Among these 66 patients, 52 had transabdominal devascularization (16 emergency, 36 elective); 14 patients underwent devascularization with esophageal stapler transection (group I), and 38 patients had devascularization without esophageal stapler transection (group II). Another 14 patients underwent elective end-to-side proximal splenorenal shunt surgery.

Results

Postoperative mortality was 7.1% in group I, 10.5% in group II (P > 0.05). Mortality for emergency surgery was 31.2% (5/16) but there were no deaths in the elective surgery group. Overall morbidity was 57.1% in group I and 21.0% in group II (P < 0.05). The rates of variceal rebleeding were 7.1% and 7.8%; residual varices were 30.7% and 32.3%; recurrent varices were 7.6% and 5.8% following the group I and group II procedures, respectively, over a mean follow-up period of 39.9 (7–2) months. Esophageal transection–related morbidity (leak, stricture, and bleeding) was 21.4% (3/14) in group I.

Conclusions

Devascularization without esophageal stapler transection is a safe and effective procedure for adequate (urgent and long-term) control of variceal bleeding with similar results and less morbidity when compared to devascularization with esophageal transection in cirrhotic patients, as well as non-cirrhotic patients.

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Acknowledgments

The authors are grateful to Mr. A. Vengatesan, Lecturer in Statistics, Clinical Epidemiology Unit, Government Stanley Medical College and Hospital, Chennai, for his statistical guidance and analysis.

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Authors and Affiliations

  1. Department of Surgical Gastroenterology, Center for G.I. Bleed & Division of Hepato Biliary Pancreatic Diseases, Government Stanley Medical College Hospital, Old Jail Road, Royapuram, Chennai, 600 001, Tamilnadu, India

    M. Johnson FRCS, S. Rajendran MCh, T.G. Balachandar D. Kannan MCh, S. Jeswanth MCh, P. Ravichandran MCh & R. Surendran MCh

  2. The Tamilnadu Dr. M.G.R. Medical University, Chennai, Tamilnadu, India

    M. Johnson FRCS, S. Rajendran MCh, T.G. Balachandar D. Kannan MCh, S. Jeswanth MCh, P. Ravichandran MCh & R. Surendran MCh

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  1. M. Johnson FRCS
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Correspondence to R. Surendran MCh.

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Johnson, M., Rajendran, S., Kannan, T.B.D. et al. Transabdominal Modified Devascularization Procedure with or without Esophageal Stapler Transection—An Operation Adequate for Effective Control of a Variceal Bleed. Is Esophageal Stapler Transection Necessary?. World J. Surg. 30, 1507–1518 (2006). https://doi.org/10.1007/s00268-005-0754-x

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