The Sugiura procedure is feasible in an unselected, high risk population of alcoholic patients with cirrhosis who have bleeding esophageal varices and poor hepatic reserve. The Sugiura procedure controlled variceal bleeding in every patient with active bleeding and prevented early rebleeding, however, the operation is tedious, time-consuming, and has a high complication rate related to the thoracic approach. The rate of anastomotic leakage of 8.6 percent (4.8 percent in elective cases) is not as high as might be anticipated, but led to death in every case. The long-term outlook for these patients is poor, and the rebleeding rate of 37 percent in our lowest risk patients is disappointingly high. Similar results can be achieved with simpler procedures.