Experience with 46 superior mesenteric vein-inferior vena cava shunts in children is reported, with postoperative follow-up of from 2 to 15 yr. The first procedure used as an end-to-side implantation of the vena cava into the right side of the superior mesenteric vein or portal vein after ligating the cava above the iliac vessels (16 cases). In the next 30 children, the vena cava was lengthened using the left or right common iliac vein, thus obtaining better anastomosis and reversed portal flow. Patency may be definitely assumed when the esophageal varices have disappeared within 3 mo; this was observed in 33 children. Results are nearly the same with superior mesenteric vein-inferior vena cava shunt, splenorenal shunt and portacaval shunt when the respective veins of the portal system are more than 1 cm in diameter. When it is less, the superior mesenteric vein-inferior vena cava shunt is more successful than others; this is the case in children under 7 yr of age. No serious trouble was observed after the interruption of the venous circulation of the limbs and pelvis when a superior mesenteric vein-inferior vena cava shunt was performed when the patients were less than 15 yr of age.