The results of a modified Sugiura devascularisation
procedure were assessed in 14 patients with thrombosis
of the portal and splenic vein requiring surgery
for variceal hemorrhage, with no vein suitable
for orthodox shunt surgery. The venous anatomy
was determined by ultrasonography with Doppler
studies and portovenography. Liver biochemistry as
well as liver architecture on histopathology was
normal in all. The surgery was elective in 9 cases for
documented bleed from diffuse fundal gastric
varices (FGV) and emergency in 5 cases, 3 having
bleeding FGV and 2 for failure of emergency
esophageal variceal sclerotherapy. All were subjected
to a transabdominal extensive devascularisation
of the upper two third of the stomach and lower
7–10cm of the esophagus. Stapled esophageal
transection (n=11) or esophageal variceal under-running
(n=1) was performed in all with esophageal
varices. FGV were underrun. Follow up endoscopies
were done six monthly. There were 9 males and 5
females with a mean age of 17.2 years (SD 12.8).
There was no operative mortality. Acute variceal
bleeding was controlled in all patients. Over a mean
follow up of 38 months, all but one remain free of
recurrent bleeding. We conclude that a modified
Sugiura devascularisation procedure is effective in
the immediate and medium term control of variceal
bleeding in patients with “unshuntable” portal
hypertension.