A modified sugiura operation for bleeding varices in children

Riccardo A. Superina, James L. Weber, Barry Shandling*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

22 Scopus citations


Objections to portal systemic shunting in children with life-threatening hemorrhage from esophageal varices include the high incidence of postshunt encephalopathy with neurologic and psychiatric sequelae and the inability to provide an adequate shunt in very young children. We have operated on eight children in the past 4 years for bleeding varices. The causes were: portal vein thrombosis (3), congenital hepatic fibrosis (2), chronic active hepatitis (2), and cystic fibrosis (1). The ages at operation were between 2 and 17 years. These children underwent various modifications of an operation described by Sugiura. The operation we have developed is done through a single thoracoabdominal incision, dividing and anastomosing the esophagus with a stapler, preserving the vagal innervation to the pylorus and antrum, and wrapping the fundus around the distal esophagus at the site of the anastomosis. The venous drainage of the lower esophagus and of the upper stomach is divided. The operation is therefore shorter and simpler, but adheres to the principles enunciated by Sugiura. Complications include one significant postoperative anastomotic leak and one symptomatic esophageal stricture. Longterm results have been gratifying with no evidence of rebleeding from esophageal varices. We believe that our modification of the original Sugiura operation is the preferred therapy of bleeding esophageal varices when surgical intervention is indicated because it preserves the normal structure and function of the upper gastrointestinal tract as well as the portal venous drainage to the liver.

Original languageEnglish (US)
Pages (from-to)794-799
Number of pages6
JournalJournal of pediatric surgery
Issue number6
StatePublished - Dec 1983


  • Esophageal varices
  • Sugiura procedure

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health


Dive into the research topics of 'A modified sugiura operation for bleeding varices in children'. Together they form a unique fingerprint.

Cite this