Background: Bleeding from esophageal varices is the major cause of death in patients with portal hypertension. The variety of available treatment options for the esophageal varices highlight the limitations with any single mode of therapy. The ideal surgical procedure should effectively control bleeding, with as little impairment of liver function as possible and with low rates of encephalopathy. Based on this objective, we propose devascularization of the lower esophagus and upper stomach by a laparoscopic approach for the treatment of bleeding esophageal varices. Materials and Methods: This prospective study was carried out from March 1997 to March 2000 in 18 patients (14men &4 women) ranging in age from 24 to 62 years (average 46.3±11.6) who underwent a laparoscopic esophagogastric devascularization procedure as treatment for variceal hemorrhage. All patients had esophagogastric varices with history of bleeding, bleeding refractory to sclerotherapy injection or bleeding from large gastric varices. Under general anesthesia, with the patient placed in a dorsal lithotomy position, the intervention began by dissection of the diaphragmatic hiatus and isolation of the esophagus. The lower 7-8 cm of esophagus was devascularized. Devascularization of gastric fundus was then accomplished with meticulous dissection and ligation of the short gastric vessels. The hepatogastric ligament was then opened, permitting identification, isolation and division of left gastric vessels. The dissection and ligation of the vessels at lesser curvature proceeded up to diaphragmatic hiatus with devascularization of the external varices from the retroperitoneum or mediastinum to the esophagogastric junction. Results. The procedure was done electively in 12 patients and emergently in 6 patients. The mean operative time was 111minutes (range 80 - 140 minutes). The mean estimated blood loss intraoperatively was 388 ml (range 150-650ml). Postoperative surgical intensive care unit (SICU) stay was 48 hours. The mean hospital stay was 11 days. The liver functions remained stable. Total bilirubin (preoperative (2.2±0.9mg/dL) vs. postoperative (2.1±0.9mg/dL), serum albumin (preoperative (3±0.4g/dL) vs. postoperative (2.9±0.4g/dL), prothrombin time (preoperative (9.3±1.7 min) vs. postoperative (8.9±1.6 min) demonstrated no significant changes. Postoperative Duplex sonography on portal vein & splenic vein revealed patency. The postoperative flow velocity in portal vein was 15.5±4.1cm/sec versus preoperative values 13.4±3.5cm/sec (p= 0.021). Splenic vein velocity demonstrated no changes. Bleeding recurred in 6 patients. Grade I encephalopathy developed in one patient who was treated conservatively. Follow up endoscopy ranging from 8 to 24 months showed regression of the varices from grade III & IV to grade I & II and in three patients the varices almost disappeared completely. Conclusion: Based on this study, we believe that laparoscopic devascularization of the lower esophagus and the upper stomach is a technically feasible and promising procedure, permitting a rapid recovery, reducing the global morbidity and controlling bleeding from variceal hemorrhage without exposing the patient to hazards of open surgery.