The authors describe 23 cases of distal splenorenal derivation after Warren. Of these patients, 17 received a complete followup clinical hematological and angiographic examination at an average remove of 10 months after surgery. The authors discuss their results and submit that the Warren operation, while really selcetive in most cases when performed, in the long run tends to shung rather too much blood away from the liver; in other words, the effectiveness of the shunt tends to exceed the intended drainage,which should be restricted to the gastro-esophageal vascular bed.