I'm currently on an ICU rotation and we had a guy bleed out yesterday despite using a blakemore to try and bridge him to surgery. Anyway, my homework assignment is to review the surgical interventions for refractory variceal bleeds. After doing some research, it seems like shunts are the preferred form of definitive treatment unless the person has extensive mesenteric thrombosis. In these cases some prefer to use the Sugiura procedure. Now after reading several articles describing the procedure I'm still a little lost.
The indication for the surgery is to stop variceal bleeding. In the procedure you ligate the penetrating esophageal veins that originate from the portal system - stopping the bleeding. This makes sense.
In order to maintain venous drainage of the esophagus and stomach the left gastric and paraesophageal veins are spared. Their anastomoses with the azygous system allows venous drainage. Also makes sense.
And a splenectomy is performed. I suspect because it has become congested and nonfunctional (?).
My question: why transect the esophagus?
I thought my understanding of anatomy would help me with this but I'm thinking I'm not seeing the "big picture" here. Thanks in advance to anyone who wants to help me out! (oh and please feel free to make a fool out of me if I'm missing something completely obvious. It's already been that kind of week...)
The indication for the surgery is to stop variceal bleeding. In the procedure you ligate the penetrating esophageal veins that originate from the portal system - stopping the bleeding. This makes sense.
In order to maintain venous drainage of the esophagus and stomach the left gastric and paraesophageal veins are spared. Their anastomoses with the azygous system allows venous drainage. Also makes sense.
And a splenectomy is performed. I suspect because it has become congested and nonfunctional (?).
My question: why transect the esophagus?
I thought my understanding of anatomy would help me with this but I'm thinking I'm not seeing the "big picture" here. Thanks in advance to anyone who wants to help me out! (oh and please feel free to make a fool out of me if I'm missing something completely obvious. It's already been that kind of week...)