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Abstract
Portal hypertension in adults is most frequently a result of nutritional or postnecrotic cirrhosis. Portal thrombosis is the most common cause in children. Portal-systemic venous shunts are the only means available to lower portal pressure permanently and to prevent variceal hemorrhage. Operative mortality and long-term survival are directly related to residual hepatic reserve. Criteria for assessment of hepatic reserve and experience with portacaval shunts are presented.