Choice of shunting operation in portal hypertension. LUO Meng, WU Zhi-yong. Department of General Surgery，Renji Hospital，Shanghai Jiaotong University School of Medcine，Shanghai 200127，China Corresponding author: WU Zhi-yong, E-mail: zhengwk@online.sh.cn Abstract Hemodynamic assessment is conducive to the choice of operative approaches and plays a critical role in the surgical treatment in portal hypertension. Total portosystemic shunts are indicated if hemodynamic examinations disclose a total hepatofugal portal blood flow. When the portal perfusion is decreased moderately, even shunting operation or devascularization is suitable. When the portal perfusion is decreased slightly, splenectomy and devascularization is preferred. FPP after splenectomy and devascularization may be a gist of choice of surgical approaches in portal hypertention. The spleno-renal shunt operation or combined operation should be performed in the patients when FPP is over 22 mmHg（1mmHg=0.133kPa） after devascularization, otherwise the devascularization should be indicated. Combined procedures have the advantages of devascularization and shunting, and should be the choice of surgical procedure in portal hypertention.