Treatment for intractable variceal bleeds. Uses devascularization of esophagus to level of inferior pulmonary vein and devascularization of proximal 2/3 of stomach, splenectomy, selective vagotomy, and pyloroplasty or highly selective vagotomy without pyloroplasty. Left gastric (coronary) vein is preserved, hepatic function is not compromised, and no encephalopathy occurs. Operative mortality is 5%Ð10% if procedure is per formed electively and 25% if performed nonelectively. Results have been superior in Japan.