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SUMMARY The usefulness of selective transplenic decompression of oesophageal varices by distal splenorenal shunt and splenocaval shunt was evaluated in the control of gastrointestinal haemorrhage in patients with portal hypertension of varied aetiology. (Decompression was successful in 69 out of 78 cases.) It was shown that it is superior to total portosystemic shunts, as the incidence of encephalopathy was very low compared with the data from our series of portocaval shunts. The operative mortality has been progressively lowered and has now reached levels comparable with portocaval shunt. Distal splenorenal shunt when performed as an emergency procedure to arrest bleeding has limited usefulness but when performed as an elective or prophylactic procedure its results are comparable with those of portocaval shunt without the untoward complications such as encephalopathy. A modified selective decompression of varices has been described in which the distal end of the splenic vein is anastomosed to the inferior vena cava. Though no long term follow-up studies are available, we believe that this shunt is likely to prove superior to distal sp]enorenal shunt as it has both the advantages of the distal splenoral and the haemodynamic advantage of end-to-side portocaval shunt. We conclude that in patients with portal hypertension of varied aetiology, who have not had a haemorrhagic episode but in whom varices have been demonstrated or who have had one episode of haemorrhage from varices, the splenocaval shunt when feasible or the distal splenorenal shunt offers the optimal method of management at present in India. (Warren et al., 1972(Warren et al., , 1974Thomford et al., 1975) we once again focused our attention on this shunt; hitherto, end-to-side portocaval shunt was the procedure of choice (and is still done in cases where the splenic vein is diseased). Seventy-three cases of portal hypertension with oesophageal varices were treated by end-to-side portocaval shunt from 1965 to 1977.Received for publication 12 May 1978 A newer modification whereby, in 15 cases, the splenic vein was anastomosed to the side of the inferior vena cava instead of the renal vein is also included in this series of 69 shunts.In the present study we attempt to evaluate the effectiveness of splenorenal shunt in controlling gastrointestinal haemorrhage due to portal hypertension of varied aetiology. MethodsIn 69 cases, extrahepatic portal hypertension due to cavernoma was present in 17, primary portal hypertension or non-cirrhotic fibrosis in 14, while in the remaining 38 cases cirrhosis of the liver was the cause of the portal hypertension. The present study includes 10 patients in the paediatric age group (less than 12 years old). The youngest patient in the series was 5 years old, and the oldest was 55 years (Table 1). There were 50 male and 19 female patients. Fourteen patients presented with a lump in the abdomen, 48 had a history of gastrointes-

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