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

Journal of Medical Case Reports

Chung-Bao Hsieh²  Teng-Wei Chen²  Hsiu-Lung Fan²  Chi-Yang Liao¹  An-Chieh Feng² 

[1] Department of Surgery, Song Shan Branch, Tri-Service General Hospital, National Defense Medical Center, 131 Jiankang Road, Taipei 105, Taiwan;Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, No.325, Sec. 2, Chenggong Rd., Taipei 11490, Neihu Dist., Taiwan

关键词: Liver cirrhosis;    Portal hypertension;    Variceal bleeding;    Liver transplantation;    Sugiura procedure;   

Others  :  1145409
DOI  :  10.1186/s13256-015-0522-y

 received in 2014-10-08, accepted in 2015-01-08,  发布年份 2015

【 摘 要 】

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.

【 授权许可】

   
2015 Feng et al.; licensee BioMed Central.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Borgonovo G, Costantini M, Grange D, Vons C, Smadja C, Franco D: Comparison of a modified Sugiura procedure with portal systemic shunt for prevention of recurrent variceal bleeding in cirrhosis. Surgery 1996, 119:214-21.
• [2]Sugiura M, Futagawa S: A new technique for treating esophageal varices. J Thorac Cardiovasc Surg 1973, 66:677-85.
• [3]Selzner M, Tuttle-Newhall JE, Dahm F, Suhocki P, Clavien PA: Current indication of a modified Sugiura procedure in the management of variceal bleeding. J Am Coll Surg 2001, 193:166-73.
• [4]Ginsberg RJ, Waters PF, Zeldin RA, Spratt EH, Shandling B, Stone RM, et al.: A modified Sugiura procedure. Ann Thorac Surg 1982, 34:258-64.
• [5]Jalan R, Redhead DN, Simpson KJ, Elton RA, Hayes PC: Transjugular intrahepatic portosystemic stent-shunt (TIPSS): long-term follow-up. QJM 1994, 87:565-73.
• [6]Eesa M, Clark T: Transjugular intrahepatic portosystemic shunt: state of the art. Semin Roentgenol 2011, 46:125-32.
• [7]Casado M, Bosch J, Garcia-Pagan JC, Bru C, Banares R, Bandi JC, et al.: Clinical events after transjugular intrahepatic portosystemic shunt: correlation with hemodynamic findings. Gastroenterology 1998, 114:1296-303.
• [8]Ma YG, Li XS, Zhao J, Chen H, Wu MC: Modified Sugiura procedure for the management of 160 cirrhotic patients with portal hypertension. Hepatobiliary Pancreat Dis Int 2004, 3:399-401.
• [9]Tsimoyiannis EC, Gossios KJ, Tsianos EV: Modified Sugiura’s procedure may improve liver function in portal hypertension. Hepatogastroenterology 1997, 44:492-5.
• [10]Mercado MA, Chan C, Zenteno-Guichard G, Vasques M, Hernandez J, Orozco H: Results of surgical treatment (modified Sugiura-Futagawa operation) of portal hypertension associated to complete splenomesoportal thrombosis and cirrhosis. HPB Surg 1999, 11:157-62.
• [11]Shah SR, Nagral SS, Mathur SK: Results of a modified Sugiura’s devascularisation in the management of “unshuntable” portal hypertension. HPB Surg 1999, 11:235-9.
• [12]Vons C, Hadengue A, Smadja C, Franco D, Lebrec D: Long-term hemodynamic effects of portocaval shunt and Sugiura procedure in patients with cirrhosis. HPB Surg 1996, 9:209-13.