Sugiura procedure outside Japan. The Mexican experience |
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| Authors: | H Orozco F Juarez M Uribe J Hernandez J Ordorica R Armenta M Aranceta M A Mercado P Santillan A Mendoza |
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| Institution: | 1. Divisions of Gastrointestinal Oncology, Shizuoka Cancer Center, Shizuoka, Japan;2. Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan;3. Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, Shizuoka, Japan;4. Medical Oncology, Shizuoka Cancer Center, Shizuoka, Japan;5. Division of Medical Oncology, Ishikawa Prefectural Central Hospital, Kanazawa, Japan;1. Division of Nephrology, Massachusetts General Hospital, Boston, Massachusetts, USA;2. Division of Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA;1. Department of Transplant and Endocrine Surgery, Kidney Disease Center, Nagoya Daini Red Cross Hospital, Nagoya, Japan;2. Department of Nephrology, Kidney Disease Center, Nagoya Daini Red Cross Hospital, Nagoya, Japan;1. Blood Bank, UMAE Hospital de Gineco Obstetricia No. 4 “Luis Castelazo Ayala”, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico;2. Department of Archaeogenetics, Max Planck Institute for the Science of Human History (MPI-SHH), Jena, Germany;3. Molecular Genetics Laboratory, Escuela Nacional de Antropología e Historia (ENAH), Mexico City, Mexico;4. Institute for Experimental Cellular Therapy, University Hospital Essen, Essen, Germany;5. Immunogenetics Unit, Técnicas Genéticas Aplicadas a la Clínica (TGAC), Mexico City, Mexico;6. Histocompatibility Laboratory, Hospital de Especialidades, Centro Médico Nacional de Occidente (CMNO), Instituto Mexicano del Seguro Social (IMSS), Guadalajara, Jalisco, Mexico;7. Immunology Division, Unidad Médica de Alta Especialidad (UMAE) # 1, Instituto Mexicano del Seguro Social (IMSS), León, Guanajuato, Mexico;8. Laboratory of Histocompatibility, Unidad Médica de Alta Especialidad (UMAE) # 71, Instituto Mexicano del Seguro Social (IMSS), Torreón, Coahuila, Mexico;9. HLA Laboratory, Central Blood Bank, Hospital de Especialidades, Unidad Médica de Alta Especialidad (UMAE) Centro Médico Nacional “Siglo XXI”, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico;10. Microbiology Department, Faculty of Medicine, Universidad Autónoma de Coahuila, Torreón, Coahuila, Mexico;11. Department of Transplantation, Unidad Médica de Alta Especialidad (UMAE) # 71, Instituto Mexicano del Seguro Social (IMSS), Torreón, Coahuila, Mexico;12. Blood Bank, Hospital Infantil de México “Federico Gómez”, Mexico City, Mexico;13. Central Blood Bank, Hospital de Especialidades, Unidad Médica de Alta Especialidad (UMAE) Centro Médico Nacional “Siglo XXI”, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico;14. Department of Nephrology and Transplantation Unit, Centro Médico Nacional de Occidente (CMNO), Instituto Mexicano del Seguro Social (IMSS), Guadalajara, Jalisco, Mexico;15. Central Office of Transplantation, Centro Médico Nacional de Occidente (CMNO), Instituto Mexicano del Seguro Social (IMSS), Guadalajara, Jalisco, Mexico;p. Direction of Health Education and Research, Unidad Médica de Alta Especialidad (UMAE) # 71, Instituto Mexicano del Seguro Social (IMSS), Torreón, Coahuila, Mexico;q. Central Office of Nephrology, Centro Médico Nacional de Occidente (CMNO), Instituto Mexicano del Seguro Social (IMSS), Guadalajara, Jalisco, Mexico;r. Laboratory of Immunobiology and Genetics, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico;s. Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Mexico City, Mexico;t. Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Boston, MA, USA;u. Immunology and Infectology Research Unit, Infectology Hospital, Centro Médico Nacional “La Raza”, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico;v. Department of Transplantation, Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán” (INCMNSZ), Mexico City, Mexico;1. Department of Surgery, University of Cape Town Health Sciences Faculty, Cape Town, South Africa;2. Department of Medicine, University of Cape Town Health Sciences Faculty, Cape Town, South Africa;3. Surgical Gastroenterology Unit, Groote Schuur Hospital, Observatory, Cape Town, South Africa;4. Trauma Centre, Groote Schuur Hospital, Observatory, Cape Town, South Africa |
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| Abstract: | In the last 10 years, we operated on 231 patients with hemorrhagic portal hypertension. Most of these patients had some form of liver disease. We performed various surgical procedures: 47 conventional shunts with H grafts and terminolateral portacaval shunts with arterialization of the portal stump, 139 selective Warren shunts, and in those patients in whom a selective portasystemic shunt could not be performed for technical reasons, esophagogastric devascularization in the form of the Sugiura procedure. Forty-five patients were treated with the Sugiura procedure as a one stage or two stage procedure. A total of 68 emergency and elective operations were performed. The operative mortality rate for the emergency thoracic operation was 41 percent and for the abdominal operation, 42 percent. The overall operative mortality rate in the emergency group was 41 percent. The incidence of recurrent variceal bleeding and encephalopathy was 0 in the surviving patients. The survival rate at 3 year follow-up was 40 percent. The elective group was made up of 24 patients. Eighteen patients had a two stage procedure and 6 patients had a one stage procedure. The operative mortality rate for the abdominal operation was 11 percent, whereas that for the thoracic operation was 7 percent. The operative mortality rate for the one stage procedure was 16 percent. The overall operative mortality rate in the elective group was 10.8 percent. None of these patients had recurrent variceal bleeding and encephalopathy developed in only one (5 percent). The encephalopathy was easily controlled with medical treatment. The 3 year survival rate was 83 percent. We conclude that the Sugiura procedure is an effective procedure to treat hemorrhagic portal hypertension when a selective shunt cannot be performed. |
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