■ During the devascularization procedure, every shunting vein between the dilated paraesophageal collateral veins and esophageal wall should be ligated. Care should be taken not to damage the truncus vagalis and collateral veins, which are theoretically very important in preventing variceal recurrence. Although this is not always practically achievable, collateral channels in the mediastinum are believed to be preserved during the operation.
■ A lasting extirpation of esophageal varices after nonshunting operation may depend on the portosystemic collateral changes that take place after the operation. Preserved paraesophageal and mediastinal collateral channels after the Sugiura operation are expected to function as a spontaneous shunt.
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For centuries, ever since the legendary Ponce de Leon went searching for the elusive Fountain of Youth, people have been looking for ways to slow down the aging process. Medical science has made great strides in keeping people alive longer by preventing and curing disease, and helping people to live healthier lives. Average life expectancy keeps increasing, and most of us can look forward to the chance to live much longer lives than our ancestors.