Elective Splenectomy Combined with Modified Hassab’s or Sugiura Procedure for Portal Hypertension in Decompensated Cirrhosis

Abstract

Objective. Portal hypertension is a major complication of decompensated cirrhosis. In China, modified Hassab’s and Sugiura procedure are the two major methods of nonshunting surgery. This study aims to compare the efficacy and safety of the two procedures for portal hypertension. Method. Between January 1994 and December 2009, 172 elective patients diagnosed with decompensated cirrhosis with significant hypersplenism adopted elective splenectomy for hypersplenism, and also modified Hassab’s (n = 91) or Sugiura (n = 81) procedure was additionally performed to reduce the risk of variceal bleeding. Postoperative mortality and morbidity data were collected, and a retrospectively comparative analysis was conducted. Results. All of the patients were treated successfully without death during operation, and no variceal bleeding occurred during hospitalization. There were 4 (4.4%) deaths in Hassab’s group and 3 (3.7%) deaths in Sugiura group postoperatively (P > 0.05). During follow-up, the survival rate was 90.2%, 82.42%, and 71.43% in Hassab’s group and 96.29%, 81.48%, and 75.31% in Sugiura group in 1, 3, and 5 years (P > 0.05). There were 22/71 and 12/63 patients in each groups who suffered no deadly variceal bleeding (P = 0.11). Bleeding related death and no bleeding related death occurred in 7/23 and 3/13 patients in each group (P = 0.26 and 0.14, respectively). Conclusion. Elective splenectomy combined with modified Sugiura procedure seemed to be associated with a reduced trend of no deadly variceal bleeding compared with Hassab’s procedure. As statistical significance was not found, further large scale and prospective study was warranted.

Surgical outcome of extrahepatic portal venous obstruction: Audit from a tertiary referral centre in Eastern India

“…Surgery may be the preferred approach for secondary prophylaxis, as it does not require stringent follow-up as required in endoscopic management [15]. A PSS is preferred to devascularization procedure wherever feasible for lower re-bleeding rate [25,26]. In the present series, 94.3% patients (n = 166) with shuntable vein (n = 176) underwent PSS.…”

Surgical Tactics for Failure of Stapler Esofago-Esofagoanastomosis During Esophagastric Devascularization

“…Модифицированная операция Sugiura включает, помимо трансабдоминальной спленэктомии, гастроэзофагеальную деваскуляризацию и дополнительно -транссекцию с реанастомозированием дистального отдела пищевода на расстоянии 4-6 см выше кардии, что способствует более полной деваскуляризации перфорантных и подслизистых вен пищевода [13,14,15,16,17,18]. В публикациях, посвященных нешунтирующим операциям, уделяется внимание обсуждению их влияния на портальное давление.…”