Q) What is not true regarding Sugiura's procedure for Portal Hypertension
a) It is a transesophageal variceal ligation
b) Splenectomy is done
Sugiura procedure is the nonshunting procedure for EV bleeding, which was first proposed by Sugiura and Futagawa in 1973 . However, because of its complexity and high postoperative morbidity and mortality, this procedure has not been widely accepted in Western countries
Non shunt operations are done for bleeding esophageal varices in emergency for poor risk patients when sclerotherapy or other conservative methods fail.
Sugiura's is a devascularization procedure described in 1973, It has two parts
Thoracic and abdominal which may be simultaneous or staged. The Left posterolateral thoracotomy is done. The longitudinal periesophageal azygous collateral veins and thoracic vagus is preserved. The esophagus is transected at level of diaphragm. This completely devascularizes the esophagus. The cut mucosa and anterior muscle layer is approximated.
Then the abdominal approach is done and abdominal esophagus, cardia of stomach is devascularized. Short gastric vessels are ligated, selective vagatomy is done, pyloroplasty is done, splenectomy completes the procedure.
Transgastric varix ligation was done previous to this procedure as described by Tanner but not transesophageal. Hence 'a' is the answer.
The modified Sugiura procedure can be performed through a one-stage transabdominal approach via the midline incision or extension of a left subcostal incision with the exposure of an L shape.
The procedure starts with splenectomy for improvement of the exposure followed by gastric and esophageal devascularization and finally the esophageal transaction using a mechanical stapler through a short gastrotomy.
The Sugiura operation contains five componential procedures and esophagogastric devascularization is the only remaining part in the many different versions of the modified Sugiura operation.