The modified Sugiura procedure as bridge surgery for liver transplantation: a case report

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• 作者：An-Chieh Feng (1)
  Chi-Yang Liao (2)
  Hsiu-Lung Fan (1)
  Teng-Wei Chen (1)
  Chung-Bao Hsieh (1)
  
  1. Division of General Surgery ; Department of Surgery ; Tri-Service General Hospital ; National Defense Medical Center ; No.325 ; Sec. 2 ; Chenggong Rd. ; Neihu Dist. ; Taipei ; 11490 ; Taiwan
  2. Department of Surgery ; Song Shan Branch ; Tri-Service General Hospital ; National Defense Medical Center ; 131 Jiankang Road ; Taipei ; 105 ; Taiwan
  
• 关键词：Sugiura procedure ; Liver transplantation ; Variceal bleeding ; Portal hypertension ; Liver cirrhosis
• 刊名：Journal of Medical Case Reports
• 出版年：2015
• 出版时间：December 2015
• 年：2015
• 卷：9
• 期：1
• 全文大小：1,626 KB
• 参考文献：1. Borgonovo, G, Costantini, M, Grange, D, Vons, C, Smadja, C, Franco, D (1996) Comparison of a modified Sugiura procedure with portal systemic shunt for prevention of recurrent variceal bleeding in cirrhosis. Surgery 119: pp. 214-21 CrossRef
  2. Sugiura, M, Futagawa, S (1973) A new technique for treating esophageal varices. J Thorac Cardiovasc Surg 66: pp. 677-85
  3. Selzner, M, Tuttle-Newhall, JE, Dahm, F, Suhocki, P, Clavien, PA (2001) Current indication of a modified Sugiura procedure in the management of variceal bleeding. J Am Coll Surg 193: pp. 166-73 CrossRef
  4. Ginsberg, RJ, Waters, PF, Zeldin, RA, Spratt, EH, Shandling, B, Stone, RM (1982) A modified Sugiura procedure. Ann Thorac Surg 34: pp. 258-64 CrossRef
  5. Jalan, R, Redhead, DN, Simpson, KJ, Elton, RA, Hayes, PC (1994) Transjugular intrahepatic portosystemic stent-shunt (TIPSS): long-term follow-up. QJM 87: pp. 565-73
  6. Eesa, M, Clark, T (2011) Transjugular intrahepatic portosystemic shunt: state of the art. Semin Roentgenol 46: pp. 125-32 CrossRef
  7. Casado, M, Bosch, J, Garcia-Pagan, JC, Bru, C, Banares, R, Bandi, JC (1998) Clinical events after transjugular intrahepatic portosystemic shunt: correlation with hemodynamic findings. Gastroenterology 114: pp. 1296-303 CrossRef
  8. Ma, YG, Li, XS, Zhao, J, Chen, H, Wu, MC (2004) Modified Sugiura procedure for the management of 160 cirrhotic patients with portal hypertension. Hepatobiliary Pancreat Dis Int 3: pp. 399-401
  9. Tsimoyiannis, EC, Gossios, KJ, Tsianos, EV (1997) Modified Sugiura鈥檚 procedure may improve liver function in portal hypertension. Hepatogastroenterology 44: pp. 492-5
  10. Mercado, MA, Chan, C, Zenteno-Guichard, G, Vasques, M, Hernandez, J, Orozco, H (1999) Results of surgical treatment (modified Sugiura-Futagawa operation) of portal hypertension associated to complete splenomesoportal thrombosis and cirrhosis. HPB Surg 11: pp. 157-62 CrossRef
  11. Shah, SR, Nagral, SS, Mathur, SK (1999) Results of a modified Sugiura鈥檚 devascularisation in the management of 鈥渦nshuntable鈥?portal hypertension. HPB Surg 11: pp. 235-9 CrossRef
  12. Vons, C, Hadengue, A, Smadja, C, Franco, D, Lebrec, D (1996) Long-term hemodynamic effects of portocaval shunt and Sugiura procedure in patients with cirrhosis. HPB Surg 9: pp. 209-13 CrossRef
  
• 刊物主题：Medicine/Public Health, general; General Practice / Family Medicine; Public Health; Primary Care Medicine;
• 出版者：BioMed Central
• ISSN：1752-1947

文摘

Introduction Esophagogastric varices bleeding is a common complication due to portal hypertension in patients with liver cirrhosis. With the advancement of nonoperative management including vasoactive agents, endoscopic hemostasis or transjugular intrahepatic portosystemic shunt, surgical management has played a lesser role in recent decades. The present report describes a patient with hepatitis B (HBV)-related liver cirrhosis and portal vein thrombosis with recurrent esophagogastric varices bleeding despite the use of medical and endoscopic therapy. The modified Sugiura procedure was performed as an alternative bridge surgery for liver transplantation in order not to change the anatomic structure of the great vessels and to avoid hepatic encephalopathy related to shunting procedures like the transjugular intrahepatic portosystemic shunt. Case presentation A 56-year-old Chinese man with a history of portal hypertension due to HBV-related liver cirrhosis and known former recurrent esophageal varices bleeding status post Sengstaken-Blakemore tube tamponade was referred to our hospital for liver transplantation evaluation because of persistent esophagogastric varices bleeding with hypovolemic shock, even after medical and endoscopic therapies in a local hospital. As a result, liver cirrhosis with Child-Pugh class B function was diagnosed. Despite the use of vasoactive agents, and endoscopic hemostasis management, esophagogastric varices bleeding still occurred episodically with hypovolemic shock, which could not be reversed by blood transfusion or Sengstaken-Blakemore tube tamponade. The modified Sugiura procedure, as an alternative bridge therapy for patients who are candidates for liver transplantation, was performed, despite the fact that his liver transplantation was not yet completed. He then received a living donor liver transplantation with the right lobe of liver from his daughter. The postoperative course was uneventful, and he was discharged two weeks later. He had no evidence of recurrent esophagogastric varices bleeding during the six-month follow-up. Conclusions The treatment experience of this case gave us not only the idea but also the practical way of applying the modified Sugiura operation as a bridge and rescue therapy without alteration of the vascular anatomy and hemodynamic stability for patients who have experienced refractory esophagogastric varices bleeding, despite the use of medication and endoscopic treatment, and are candidates for receiving a liver transplantation.