Abstract
Surgical options for acute variceal bleeding should be considered when injection sclerotherapy fails on two occasions. Which surgical approach is used depends on local expertise, compliance of the patient, Child’s grade, and the availability of liver transplantation. In the acutely bleeding situation the choice probably lies between the esophageal transection and devascularization procedure and a mesocaval shunt. The Sugiura procedure has little merit outside Japan, and an emergency portacaval shunt should be avoided in patients who are possible liver transplant recipients.
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