Transabdominal extensive esophagogastric devascularization with gastroesophageal stapling for management of noncirrhotic portal hypertension: Long-term results

Outside Japan portosystemic shunts have been favored as the surgical proced ure of choice for the management of portal hypertension of noncirrhotic eti ology, Devascularization procedures have resulted in high rebleed rates pro bably owing to a limited extent of devascularization. we performed this stu dy to assess the efficacy of our modification of Sugiura's procedure for lo ng-term control of variceal bleeding in patients with noncirrhotic portal h ypertension. Forty six patients with extrahepatic portal venous obstruction (EHPVO) and 22 with noncirrhotic portal fibrosis (NCPF) were subjected to transabdominal extensive esophagogastric devascularization with esophageal or gastric stapled transection (modified Sugiura's procedure), 38 in an eme rgency situation and 30 electively. Follow-up endoscopies were performed ev ery 6 months. Operative mortality, morbidity, variceal status, and causes o f recurrent bleeding were evaluated. The postoperative mortality was 4%. Ea rly procedure-related complications were seen in 6%, and esophageal strictu res formed in 7 of 45 survivors undergoing esophageal transection (15%). Ov er a mean +/- SD follow-up of 53 +/- 34 months, 95% of patients were free o f varices. Seven survivors (11%) had a rebleed, but only 5% were due to var ices (two esophageal, one gastric). Six (9%) patients developed gastropathy . The 5-year survival was 88%. The modified Sugiura's procedure is safe and effective for long-term control of variceal bleeding especially in the eme rgency setting and in patients with anatomy unsuitable far shunt surgery or if surgical expertise for a shunt operation is not available.