Distal spleno-renal anastomosis is worth consideration in the treatment of certain forms of portal hypertension, especially when there is a satisfactory portal blood flow. Apart from the low operative mortality and morbidity its main advantages are the preservation of portal hepatic blood flow, the reduction or suppression of which may have a deleterious effect on the liver, and also avoid or reduce to a minimum the risk of portal systemic encephalopathy, while producing effective decompression of the oesophageal varices. This operation is contra-indicated in presence of a greatly reduced or inversed portal blood flow, and also in cases of ascites or marked stasis of the splanchnic or retroperitoneal lymphatic network.