A Merdad, A Sibiany, Modified Sugiura Procedure for Nonalcoholic Bleeding Esophageal Varices. 1995; 15(4): [407][408][409] Thirty-one patients with bleeding esophageal varices (Child's class A and B) were treated by a modified Sugiura procedure; 24 were Child's class A and seven were Child's class B. All patients were nonalcoholic, 19 (61%) had liver disease secondary to schistosomiasis. There were no deaths. The morbidity rate was high (65%) but all were managed successfully. Early dysphagia occurred in 11 patients (35%); five progressed to strictures which required repeated dilatations. All patients except one lost to follow-up at six months are alive three to six years after their surgery. There has been no recurrence of bleeding and no encephalopathy.The main goals for intervention in bleeding esophageal varices are to control the bleeding, prevent recurrence and maintain hepatopedal blood flow to avoid deterioration of liver function and encephalopathy.Whether in portal decompression or direct approach to the varices, the patient's outcome depends mainly on the stage of his liver disease.Controversy still exists about the optimal treatment for the bleeding esophageal varices; 1,2 portal decompression procedures are less favored for nonalcoholic patients due to the postoperative encephalopathy and possible deterioration of liver function. Extensive esophagogastric devascularization with esophageal transection and splenectomy as reported by Sugiura et al. produced excellent results in controlling variceal bleeding with low operative mortality and no increase in encephalopathy.3-6 Several modifications of the original Sugiura procedure were reported with different results. 7-11In 1987, we embarked on this study to evaluate the efficacy of a modified Sugiura operation [12][13][14] in the treatment of patients with bleeding esophageal varices, Child's class A and class B. Patients in Child's class C were treated with sclerotherapy, esophageal transection and possible referral for liver transplant. This article describes the results with follow-up ranges between three to six years. MethodsFrom 1987 to 1990, 31 patients underwent a modified version of the Sugiura procedure for the bleeding esophageal varices.All bleeding patients were resuscitated and treated medically by restoring blood volume and correcting coagulation abnormalities. Intravenous vasopressin and balloon tamponade were used if required.Hematological and biochemical blood work was obtained and the patients were graded according to Child's classification. Patients graded Child's class A and class B were included in this study. Child's class C patients or those with previous surgery for their varices were treated with early injection sclerotherapy, esophageal transection if sclerotherapy failed and considered for referral for liver transplant.Cases were considered emergent if bleeding was not controlled by medical measures, considered urgent if bleeding was controlled and surgery was performed during the same hospital admission (usually within two we...

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