Fourteen patients (age range, 11-73 years) underwent side-to-side splenorenal venous anastomosis with ligation of the splenic artery and preservation of the spleen. Half of these patients were actively bleeding, seven were jaundiced, and 11 had ascites. Biliary tract surgery had been performed in seven, and four had thrombosed portal veins. All survived operation. There were three hospital deaths, one each from liver failure, pancreatitis, and cancer. Four of the 11 patients who left the hospital subsequently died from the effects of continued alcohol ingestion in six months to six years. Postoperative morbidity was considerably lower than for portacaval shunt. Hypersplenism, present in seven patients, was rapidly reversed after operation and esophageal varices regressed. Seven patients are living and asymptomatic six months to five years after operation. We conclude from this experience that side-to-side splenorenal shunt is a simple, useful, and rational technique for portal hypertension.