[Esophageal closed transection for surgical treatment of portal hypertension. A 10-year experience].

BACKGROUND

Extensive esophagogastric devascularization (Sugiura-Futagawa operation and complete portoazygos disconnection) are excellent alternate choices for low-risk patients (Child-Pugh A-B) in whom a selective shunt is not feasible, obtaining a low postoperative rebleeding rate and a good quality of life. Esophageal transection is an important step in these procedures because submucosal varices are obliterated, achieving complete portoazygos disconnection. Results during one decade with closed variant of esophageal transection are reported.

METHOD: Between 1990 and 2000, 78 patients were operated on (69 Child-Pugh A and nine Child Pugh B) in two operative stages with Sugiura-Futagawa operation and complete portoazygos disconnection. Files of these patients were reviewed and recurrence of hemorrhage was evaluated as well as fistulization and dehiscence.

RESULTS

Among 78 modified transections, only one case of dehiscence was observed (1.2%) (very early in our experience) with concomitant mortality. Rebleeding was observed in 11% of cases, with two cases of stenosis that required dilatation. During the last 7 years (57 patients), no complication has been observed.

CONCLUSIONS

Modified transection has a very low complication rate with long-term results comparable to those of classic transection.