SURGICAL-MANAGEMENT OF EXTRAHEPATIC PORTAL-HYPERTENSION AND VARICEAL BLEEDING

Variceal bleeding remains an important complication in extrahepatic po rtal vein thrombosis (EPVT). As for portal hypertension due to other e tiologies, an elective treatment to decrease the risk of subsequent re bleeding is warranted. The results of the Sugiura-Futagawa procedure ( SP) in 38 patients with variceal bleeding secondary to EPVT are report ed: 20 women and 18 men, with a mean age of 28 +/- 2 years (SEM). Thir ty-seven patients were classified as Child-Pugh class A, and one patie nt as class B. In terms of diagnosis, 45% of patients had idiopathic E PVT, and 18% had associated hypercoagulability disorders; 52% of patie nts had associated splenic vein thrombosis. The SP was completed in tw o surgical stages in 18 patients and in one surgical stage in 14; 6 pa tients had only the abdominal stage. One patient had mild postoperativ e encephalopathy, and three patients rebled at long-term follow-up stu dy. There were two operative deaths. Actuarial survival was 70% at 64 months. It is concluded that the SP is an excellent alternative for pa tients with variceal bleeding secondary to EPVT.