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The Sugiura procedure is a surgical technique primarily used in the management of esophageal varices, which are swollen veins in the esophagus that can rupture and lead to severe bleeding, a common complication in patients with portal hypertension, often due to liver cirrhosis. This procedure involves the creation of an esophagogastric devascularization and splenectomy, aimed at reducing the pressure in the portal venous system and subsequently decreasing the risk of variceal bleeding. During the surgery, the surgeon typically makes an incision in the abdominal cavity to access the esophagus and surrounding tissues. The procedure specifically targets the branches of the gastric arteries and involves ligating or cutting them to reduce blood flow to the varices. Additionally, the spleen is removed to decrease spleenic blood flow, which contributes to portal hypertension. By addressing these issues, the Sugiura procedure effectively mitigates the risk of bleeding. It is often considered for patients who have had prior episodes of variceal bleeding or are at high risk of such events and may not be candidates for other interventions like transjugular intrahepatic portosystemic shunt (TIPS) or endoscopic therapy. The Sugiura procedure can be performed through an open surgical approach or laparoscopically, depending on the surgeon's expertise and the individual patient's condition. Recovery from the surgery involves close monitoring for potential complications such as infection, bleeding, or adverse reactions to anesthesia. The success of the Sugiura procedure is generally evaluated based on the improvement in the patient's overall condition and the prevention of further esophageal bleeding. Studies have shown that this surgical technique can significantly reduce the incidence of variceal hemorrhage and improve survival rates among patients with advanced liver disease and portal hypertension. However, like any surgical intervention, it carries inherent risks, and candidates for the Sugiura procedure are thoroughly evaluated to ensure that the benefits outweigh these risks. The decision to proceed with this surgery is multidisciplinary, involving hepatologists, surgeons, and other healthcare professionals to create a comprehensive treatment plan tailored to the patient's needs. The Sugiura procedure, while effective, is less commonly performed today due to the advancements in nonsurgical management options; however, it remains an important historical approach in the treatment of esophageal varices. In conclusion, the Sugiura procedure is a strategic surgical intervention aimed at reducing the life-threatening risks associated with bleeding varices in patients suffering from portal hypertension, contributing to an improved quality of life and better long-term outcomes for those with severe liver disease.