Systemic and splanchnic hemodynamics were studied before and six months after a portal systemic shunt n6 or a sugiura procedure n9 in 15 patients with cirrhosis and a past history of variceal bleeding. The resulting procedure has been known as the sugiura procedure. Surgery mcqs with explanations surgery mcqs from exams. All bleeding patients were resuscitated and treated medically by restoring blood volume and correcting coagulation abnormalities. Sugiura procedure in portal hypertensive children springerlink. Elective splenectomy combined with modified hassabs or sugiura. Although portasystemic venous shunt operations were common previously, they are now regarded as. Three different approaches will be described including a spleenpreserving procedure as well as a procedure with an abdominal approach only i. As the sugiura procedure is increasingly being employed in the united states, radiologists should be familiar with the spectrum of postoperative.
The modified sugiura procedure as bridge surgery for liver transplantation. Apr 01, 2000 read devascularizationmodified sugiura procedure. A report of longterm resultsin chile, gastroenterology on deepdyve, the largest online rental service for scholarly research with thousands of academic publications available at your fingertips. The sugiura procedure is based on the principle of dividing the perforating veins of the esophagus and the stomach while maintaining the plexus of collaterals that connect the coronary vein to the azygous system. Comparative study of 2 variants of a modified esophageal. However, when acute sclerotherapy fails, and in cases where no further treatment is accessible, emergency surgery may be life saving. Laparoscopic sugiura procedure has not previously been described. One of the features of the sugiura futagawa procedure is the maintenance of portal blood flow. Sugiura received a number of awards and prizes throughout his life, and retired from the center in 1962. A new procedure for management of extrahepatic portal obstruction. The annals of thoracic surgery vol 34, issue 3, pages 225. We had hoped that we could avoid a twostaged procedure in all patients.
The modified sugiura procedure was performed in 46 patients on an. The modified sugiura procedure was performed as an alternative bridge surgery for liver transplantation in order not to change the anatomic structure of the great vessels and to avoid hepatic encephalopathy related to shunting procedures. Esophagogastric varices bleeding is a common complication due to portal hypertension in patients. Modified sugiura procedure modified sugiura procedure soonawalla, z. I had the sugiura procedure performed at the university of wisconsin hospital in 2007. A modified sugiura procedure the annals of thoracic surgery. J thorac cardiovasc the sugiura operation differs from all previsurg 66.
This series was performed during the last decade when all modern therapeutic options for variceal bleeding were available. This study aims to compare the efficacy and safety of the two procedures for portal hypertension. Further evaluation of the sugiura procedure in the. The annals of thoracic surgery vol 34, issue 3, pages. Further evaluation of the sugiura procedure in the treatment. Bleeding from esophageal varices is an important cause of morbidity and mortality in children with portal hypertension. The sugiura procedure is a surgical technique that involves the removal and transection of the. Read current indication of a modified sugiura procedure in the management of variceal bleeding 1 1 no competing interests declared. The patient is placed in a right lateral decubitus position. Between january 1994 and december 2009, 172 elective patients diagnosed with decompensated cirrhosis. A total of 276 patients had an esophageal transection with paraesophagogastric devascularization the sugiura procedure for esophageal varices from 1967 to the present. Pdf the modified sugiura procedure as bridge surgery for liver. The original technique described by sugiura and futagawa was a twostep operation consisting of an initial thoracic operation followed by the abdominal operation 34 weeks later.
Nonshunt operations, such as the sugiura procedure and hassabs operation, consist of extensive interruption of collateral vessels connecting the highpressure portal venous system in. Modified sugiura procedure for nonalcoholic bleeding. During the last three decades the sugiura procedure and other nonshunting operations have been widely performed as the operations of choice for bleeding esophageal varices in japan. The sugiura technique is based on eliminating perforating veins of esophagus and stomach, maintain collaterals which connect the coronary vein to the azygous system. Case report open access the modified sugiura procedure as bridge surgery for liver transplantation. Hepatic blood flow was estimated by hepatic extraction and clearance of continuous indocyanine green infusion.
Full text combination of modified sugiura technique and. Improving the numerical stability of the sakuraisugiura. Pdf longterm hemodynamic effects of portocaval shunt and. Standing the test of time in the treatment of bleeding esophageal varices. We chose our modification of the sugiura futagawa procedures for cases in which a shunt was not feasible, such as patients with inadequate splenic veins or anatomy or with splenoportal thrombosis. Does it have any role in the management ofvariceal bleeding. The benefit of the modified sugiura procedure proposed for the treatment of upper gi variceal bleeding developed in the context of splanchnic venous thrombosis is discussed. Sugiura procedure outside japan the mexican experience hector orozco, md, facs, federico juarez, md, misael urfbe, md, jorge hemandez, md, juan ordorica, md, romulo armenia, md, miguel aranceta, md, miguel angel mercado, md, patrick sarrtillan, md, arturo mendoza, md, manuel tietve, md and luis guevara, md, mexico city, mexico during the past 10 years, many therapeutic proce dures have been.
Kanematsu sugiura 1890 october 21, 1979 in white plains, new york was a cancer researcher who spent his career at the memorial sloankettering cancer center. Objectiveto study the safety and efficacy of the modified sugiura procedure for treating patients with portal hypertension. Modified sugiura procedure, journal of the american college. The treatment protocol is planned according to the etiologic factors underlying the portal hypertension, which may be either intrahepatic or extrahepatic. Esophageal transsection with paraesophagogastric devascularizations the sugiura procedure in the treatment of esophageal varices. Pdf sugiura procedure outside japan jorge hernandez. Between january 1994 and december 2009, 172 elective patients diagnosed with.
A pioneer in cancer research, he completed over 250 papers before his death. Objective to compare 2 techniques of esophageal transection in our modification of the sugiurafutagawa procedure for the treatment of bleeding portal hypertension in lowrisk patients who cannot undergo surgery to have shunts placed design a prospective controlled trial comparing 2 variants of transection classic, complete section of the anterior muscularis externa and whole. Longterm hemodynamic effects of portocaval shunt and sugiura procedure in patients with cirrhosis. The ssrr method can suffer from numerical instability when the coefficient matrices of the projected qep vary widely in.
The sugiura procedure is a safe and effective surgical treatment of esophageal varices in the pediatric population. This article is within the scope of wikiproject medicine, which recommends that medicinerelated articles follow the manual of style for medicinerelated articles and that biomedical information in any article use highquality medical sources. Our modifications were designed to stream line the operation while maintaining sugiura s original concept. Modified sugiura procedure, journal of the american. Pdf the modified sugiura procedure as bridge surgery for.
Portal hypertension is a major complication of decompensated cirrhosis. Pdf longterm results with the modified sugiura procedure. Current indication of a modified sugiura procedure in the. Most of these patients had some form of liver disease. Elective splenectomy combined with modified hassabs or. Pdf elective splenectomy combined with modified hassabs. The modified sugiura procedure as bridge surgery for liver. Pdf longterm results with the modified sugiura procedure for. Sugiura procedure is the nonshunting procedure for ev bleeding, which was first proposed by sugiura and futagawa in 1973. Objective to investigate whether splenectomy as a part of devascularization procedures is necessary design prospective, controlled, randomized trial setting university hospital, referral center patients a total of 55 patients childpugh class a and b with a history of bleeding portal hypertension were treated by means of a modified sugiurafutagawa procedure. Longterm results with the modified sugiura procedure for the. Longterm results with the modified sugiura procedure for the management of variceal bleeding.
Pp046 the modified sugiura procedure in treating variceal hemorrhage. After sugiura procedure, there was no significant change in cardiac index, hepatic venous pressure gradient, hepatic blood flow or azygos blood flow. If the address matches an existing account you will receive an email with instructions to reset your password. The sugiura procedure is an alternative treatment for bleeding gastroesophageal varices. Traditionally, the sugiura procedure was performed as a twostep operationa thoracic approach first, followed by an abdominal procedure. Traditionally, the sugiura procedure was performed as a twostep operationa thoracic approach first, followed by an abdominal procedure 46 weeks after the initial thoracic operation. Is splenectomy necessary in devascularization procedures for.
The modified sugiura procedure was performed as an alternative bridge surgery for liver transplantation in order not to change the anatomic structure of the great vessels and to avoid hepatic encephalopathy related to shunting procedures like the transjugular intrahepatic portosystemic shunt. Our results indicate that the modified sugiura procedure is an effective rescue therapy in patients who are not candidates for selective shunts, transhepatic portosystemic shunt, or transplantation. Read comparison of a modified sugiura procedure with portal systemic shunt for prevention of recurrent variceal bleeding in cirrhosis, surgery on deepdyve, the largest online rental service for scholarly research with thousands of academic publications available at your fingertips. Methodsthirtynine patients with portal hypertension who underwent surgical treatment with the modified sugiura procedure between september 2009 and march 2011 were retrospectively enrolled in the study. The surgery was done as i was not a candidate for a shunt and my esophageal varicies were dangerously large 4. We will be providing unlimited waivers of publication charges for accepted articles related to covid19. There is a significant lower operative mortality that favors the elective selective shunts and the sugiurafutagawa procedure. We are committed to sharing findings related to covid19 as quickly and safely as possible. In china, modified hassabs and sugiura procedure are the two major methods of nonshunting surgery. Download fulltext pdf download fulltext pdf download fulltext pdf. From 1987 to 1990, 31 patients underwent a modified version of the sugiura procedure for the bleeding esophageal varices.
Objective to compare 2 techniques of esophageal transection in our modification of the sugiura futagawa procedure for the treatment of bleeding portal hypertension in lowrisk patients who cannot undergo surgery to have shunts placed. The procedure is a valid therapy in the treatment of symptomatic extrahepatic hypertension when other options are inapplicable. The project works to allow users to contribute quality articles and media files to the encyclopedia and track their progress as they are developed. Pdf elective splenectomy combined with modified hassabs or. Although the modified sugiura procedure and hassab procedure have been used for many years, it remains unclear as to which is more effective for the treatment of. Radiographic findings in the esophagus following the. Aug 01, 2001 read current indication of a modified sugiura procedure in the management of variceal bleeding 1 1 no competing interests declared. The modified sugiura procedure was performed as an alternative bridge surgery for liver transplantation in order not to change the. The sugiura procedure for esophageal varices combines splenectomy with esophagogastric devascularization, which destroys the intraesophageal portacaval shunt but preserves periesophageal portacaval shunts. We have modified the total vagotomy and pyloroplasty and sutured esophageal anastomosis of the original operation. Can j surg in press esophagogastric varices are divided, and the 3. One patient died a year after the modified sugiura procedure of massive lower gastrointestinal bleeding presumed to be from varices of either the lower small bowel or large bowel. Ginsberg rj, waters pf, zeldin ra, spratt eh, shandling b, stone rm, strasberg s. A new procedure for management of extrahepatic portal.
Clinical outcome of the modified sugiura procedure for. Sugiura procedure definition of sugiura procedure by. However, because of its complexity and high postoperative morbidity and mortality, this procedure has not been widely accepted in western countries. The surgical approaches to the treatment of bleeding esophageal varices in cirrhotic patients have been reduced since the clinical development of endoscopic sclerotherapy, transjugular intrahepatic portosystemic shunt tips, and liver transplantation. Jan 21, 2012 the surgical approaches to the treatment of bleeding esophageal varices in cirrhotic patients have been reduced since the clinical development of endoscopic sclerotherapy, transjugular intrahepatic portosystemic shunt tips, and liver transplantation. Is splenectomy necessary in devascularization procedures. Longterm results with the modified sugiura procedure for. Modified sugiura operation for idiopathic portal hypertension. Hepatic failure, respiratory failure, and sepsis secondary to gastrointestinal leakage also occurred and were fatal in all cases. The sakuraisugiura method with rayleighritz projection ssrr method finds the eigenvalues in a certain domain of the complex plane of large quadratic eigenvalue problems qeps.
Longterm hemodynamic effects of portocaval shunt and sugiura. Sugiura procedure for management of variceal bleeding in japan. Azygos blood flow was measured with a continuous thermodilution catheter. The sugiura procedure university of tokyo method, a transthoracoabdominal esophageal transection, consists in paraesophageal devascularization, esophageal transection and reanastomosis. During the last three decades the sugiura procedure and other nonshunting operations have been widely performed as. Pdf longterm hemodynamic effects of portocaval shunt. Feb 01, 2002 modified sugiura procedure modified sugiura procedure soonawalla, z. The other patient died of pulmonary complications related to fibrocystic disease.
Sugiura procedure for management of variceal bleeding in. Longterm hemodynamic effects of portocaval shunt and. We are encouraged by the early results in all but the patients in childs class c, who underwent. It is currently performed as a single procedure with synchronous abdominal and thoracic incisions. In china, modified hassabs and sugiura procedure are the two major. This is the first study to show the longterm maintenance of splanchnic and systemic hemodynamics in patients with cirrhosis after sugiura procedure. Although portasystemic venous shunt operations were common previously, they are now regarded as nonphysiologic and are. Elective splenectomy combined with modified hassabs or sugiura procedure for portal hypertension in decompensated cirrhosis. The sugiura procedure university of tokyo method, a transthoracoabdominal esophageal transection, consists in paraesophageal devascularization, esophageal transection and reanastomosis, splenectomy, and.
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