SUGIURA PROCEDURE FOR MANAGEMENT OF VARICEAL BLEEDING IN JAPAN

During the last three decades the Sugiura procedure and other nonshunt ing operations have been widely performed as the operations of choice for bleeding esophageal varices in Japan. The Sugiura procedure (Unive rsity of Tokyo method), a transthoracoabdominal esophageal transection , consists in paraesophageal devascularization, esophageal transection and reanastomosis, splenectomy, and pyloroplasty. The results have be en satisfactory with low operative mortality and low rebleeding rate. The prognosis of the patients after this operation depended on the liv er function at the time of operation but not on whether operation was done as an emergency, elective, or prophylactic measure. Although the Sugiura procedure has recently been performed in more selected cases w ith an advance in endoscopic injection sclerotherapy, this procedure r emains the ultimate direct operation for portal hypertension in Japan.