J.Jpn. Surg. Soc.. 79(8): 707-712, 1978

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Report on the annual meeting

SURGERY IN THE TREATMENT OF ESOPHAGEAL VARICES

A total of 363 patients were submitted to esophageal transection ; 317 were the Sugiura procedure, 40 were simple esophageal transection, and 6 were transabdominal esophageal transection with paraesophagogastric devascularization.
Of 6 patients who have undergone transabdominal esophageal transection, recurrence of variceal bleeding was noted in 2 cases. The key point is that extensive paraesophagogastric devascularization is performed both transthoracically and transabdominally, and the mucosal layer of the esophagus are completely divided, which may be very important in preventing further developement or recurrence of varices. Of the group of 317 who have undergone the Suigura procedure, there were 15 (4.7%) operative deaths and 55 late deaths. Twenty-two patients displayed upper gastrointestinal bleeding after the Sugiura procedure. The most common cause of bleeding was hemorrhagic gastritis. In simple esophageal transection cases, recurrence of bleeding was noted in 20.6% and all of them died. In the Sugiura procedure, disappearance of the varices was noted in 96% of the cases, varices recurred in 2.5%, and recurrence of variceal bleeding was noted in 1.7%. The cause of recurrence of varices was due to the incomplete devascularization of the esophagus. There was an obvious positive correlation between survival rate and the stage (Child's classification) of the disease. Only 45% of class C patients are alive.
The present study reconfirmed that our method is safe and effective in controlling esophageal variceal bleeding.

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