The definitive hemostasis is the key to successful therapy of variceal bleeding. There is a difference between the emergency operation for persistent bleeding in spite of initial sclerosing therapy and the planned early operation for primary massive bleeding, early recurrence of bleeding and bleeding of fundus varicosis. The lethality is about 50% for the emergency operation, about 12% for the early operation (Berlin). For the emergency situation the portacaval end-to-side anastomosis is favoured. The result of this therapeutical concept in Bonn (1989-1990) for 47 patients admitted for bleeding was a hospital lethality of 23%.