Sugiura Procedure … A Last Resort for Variceal Bleeding

by Clint on February 20, 2012

Since first learning about the Sugiura Procedure for oesophageal bleeding, I have wanted to write something about it but had difficulty actually deciphering the material from medical terminology into language that was understandable for most.   Besides scouring the internet I also tried to find understandable information in book form at my local library, and surprisingly I came up short.  Before trying to explain (albeit briefly below) online medical dictionaries define the procedure in the following manner, “Oesophageal transection with paraoesophageal devascularisation, for oesophageal varices”. 

As best as I can describe the Sugiura procedure, surgeons would ligate (tie-off) the penetrating oesophageal veins that originate from the portal system in order to stop the bleeding.  To maintain critical venous drainage of the oesophagus and stomach the left gastric and paraesophageal veins are left intact.  A splenectomy (removal of the spleen) is performed because it is usually congested and non-functioning.  Some articles I have read indicate that there have been some modifications to the procedure and with that there has been some reported success.  Although the Japanese (University of Tokyo) have reported favourable long-term results, the technique has not been widely accepted in the Western Hemisphere (except for Mexico) because of high postoperative mortality rates.  On a recent visit to my gastroenterologist I inquired about the procedure, and she confirmed what I read and stated that it is only performed as a last resort where all other procedures have failed.

Through personal research, personal interaction I have had with other sufferers, plus the advice of a few of my own specialists I remain committed to the task of posting accurate information on new techniques and medical findings for this most disconcerting condition of portal hypertension.   The Sugiura procedure is much more complicated than what I have tried to explain here, so maybe you have more information to share than what I have provided?  At any rate your comments or questions are always welcome!

Until next time,

Clint

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{ 3 comments… read them below or add one }

Jill March 23, 2014 at 11:56 pm

I had the Sugiura procedure performed at the University of Wisconsin Hospital in 2007. A splenectomy was done at the same time. The surgery was done as I was not a candidate for a shunt and my esophageal varicies were dangerously large (4×4). I already had a serious bleed and was at high risk for another. I developed acities and other post operative issues, but did recover. For a year after the operation, I vomited or had diarrhea after nearly every meal. Eventually, this improved. I still have digestive problems, mainly with food dumping and pain. I get annual endoscopies, with banding if indicated. Portal hypertension resulted from pancreatitis and a thrombosis from a pseudo cyst. I am also diabetic. I’m wondering if others have post Sugiura digestive issues? Thanks for the web site.

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Clint April 4, 2014 at 3:16 pm

Hi Jill,

Thanks for your post. I apologize for not replying sooner, but I had issues with my blog site where I was only able to approve comments and not reply. With the help of a friend and some updates I am finally able to respond!

I’m sorry to hear of you ongoing issues, although you have had some improvement from the Sugiura. I can’t relate to actually having any kind of evasive procedure relating to PH, but have survived some close calls since my diagnosis along the way and am thankful to be alive. After some testing this past January I was also diagnosed with Diabetes.

For your digestive problems, have you tried any dietary measures? Although I have a knowledgeable gastroenterologist, and have asked her about a suggested diet, she is unable to answer this question. When I was diagnosed with diabetes, I took it upon myself to stop eating anything with wheat or grains, or milk products. After doing this my system is so much better, and I have way less pain now. Also, I would like to know if you are taking a beta blocker and any anti coagulants?

Thanks, I look forward to your response.

Have a great day!

Clint

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David July 7, 2014 at 6:22 am

Hi. I understood that not only is this a procedure of last resort, it is rarely ever done anymore because of alternative less invasive procedures. This makes the procedure even more difficult because most surgeons are no longer familiar with or practiced on the procedure. In Canada most surgeons stopped doing them in the early 1990s. Furthermore if anything goes wrong it is unlikely that younger health care workers will be familiar with the procedure and the complications. This leads me to my question: have you come across anything about the potential longterm complications beyond 20 years after the procedure?

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