Distal splenorenal shunt was performed in 17 patients with bleeding esophageal varices and/or hypersplenism. As an elective operation the results were very good, whereas the shunt should not be used as an emergency operation. During an observation period of 6-30 months none of the 13 surviving patients developed a recurrent hemorrhage or portosystemic encephalopathy. An existing hypersplenism was improved in all cases. In our opinion the distal splenorenal shunt is the optimal elective surgical management for bleeding esophageal varices, since it offers effective control of recurrent hemorrhage without the risk of encephalopathy.