COMPARATIVE-STUDY OF 2 VARIANTS OF A MODIFIED ESOPHAGEAL TRANSECTION IN THE SUGIURA-FUTAGAWA OPERATION

Objective: To compare 2 techniques of esophageal transection in our mo dification of the Sugiura-Futagawa procedure for the treatment of blee ding portal hypertension in low-risk patients who cannot undergo surge ry to have shunts placed. Design: A prospective controlled trial compa ring 2 variants of transection (classic, complete section of the anter ior muscularis externa and whole mucosa; modified, placement of a circ umferential running suture without opening the mucosa). Setting: Acade mic university hospital. Patients: Eighty-three low-risk patients (Chi ld-Pugh score A and B) with a history of bleeding portal hypertension were operated on (35 classic, 48 modified transections) between 1989 a nd 1996. Both groups were comparable. Main Outcome Measurer: Postopera tive dehiscence of the transection was evaluated as well as fistulizat ion, postoperative stenosis, rebleeding, postoperative endoscopic find ings, survival, and mortality. Results: Fistulization was observed in 1 (2%) of the patients in the modified group, and dehiscence in 1 pati ent (2%). In the classic group, 3 (8%) of the patients had dehiscence (relative risk, 2.6) and 1 (2%) of the patients, fistulization. No dif ferences were observed regarding rebleeding (6 patients [6%] vs 5 pati ents [7%]), postoperative stenosis (4 patients [8%] vs 5 patients [10% ]), postoperative endoscopic findings, survival, and mortality (early and late). Conclusion: The modified variant of the transection has a l ower frequency of postoperative dehiscence, with the same long-term re sults.