The authors report a review of the literature and describe their personal experience with treating esophageal varices; all types of surgical approaches (selective and total shunts, esophageal transection) are examined and compared to the results obtained with non surgical treatment (particularly endoscopic sclerotherapy). Indications and results of surgical treatment are discussed from three definitive viewpoints: prevention of first bleeding or prophylactic treatment, control of acute bleeding or emergency treatment and prevention of rebleeding or elective treatment.