Abstracts
2000 Digestive Disease Week

# 2275 Devascularization-Modified Sugiura Procedure. Does It Have Any Role in the Management of Variceal Bleeding? A Report of Long- Term Results in Chile.
Jorge A. Martinez, Alfonso F. Diaz, Claudia I. Aguayo, Mario A. Caracci, Rose M. Mege, Enrique E. Waugh, Julio R. Reyes, Santiago, Chile

Background: Variceal bleeding is still a medical challenge in patients with portal hypertension. In the last decade surgical approaches to this problem have been replaced by endoscopic sclerotherapy, band ligation and the use of transjugular intrahepatic portosystemic shunt (TIPS). Liver transplantation, which provides definitive treatment for end-stage liver disease, is not still widespread available in our country.The aim of this report is to retrospectively review the long-term results of the modified-devascularization Sugiura procedure (DSP) done electively in patients with variceal bleeding in a public hospital setting. Patients and methods: Between June 1980 and December 1986, 48 patients with portal hypertension complicated with esophageal variceal bleeding, were electively submitted to the modified-DSP. Preoperative Child- Pugh class was assessed before surgery in all but one patient. Overall mortality, morbidity, postoperative hospital stay and variceal bleeding recurrences were determined. All death reports and certification were obtained. Mean follow-up of all patients was 9 ±6 years. Bleeding recurrence and long-term cumulative survivals were analyzed using Kaplan-Meier curves. Differences in survival were determined by the log-rank test. Results: The operative 30-day mortality and overall morbidity were 8.3% and 43.8% respectively. Portal hypertension was due to liver cirrhosis in 42 patients and from extrahepatic origin in 6. The Child-Pugh class in cirrhotic patients was A: 15 patients (35.7 %); B: 21 (50 %) and C: 5 patients (11.9 %). In 19 cases (39.6%) there were endoscopic evidences of variceal recurrence; nine out of them needed further sclerotherapy. Eleven patients (22.9 %) re-bled during the follow-up; 3 from variceal origin. Ten-year actuarial survival was 46.7%; 27.3% and 0 % for Child-Pugh A, B, C patients respectively (p< 0.001) and 100 % in extrahepatic portal hypertension patients. Overall 10- and 15-year survival in all series was 40.4 % and 27.5 %. Conclusion: The modified-DSP may be still a good alternative surgical option in patients with variceal bleeding with well-preserved hepatic function who will not be candidates to liver transplantation.