Abstract: Esophageal variceal hemorrhage is a severe complication of portal hypertension. Non selective blockers and endoscopic variceal ligation have been utilized to prevent variceal hemorrhage as the first line therapeutic measures. The role of surgical approaches in the treatment of portal hypertension is still controversy.The selective shunt operation, devascularization operation, transjugular intrahepatic portosystemic shunt and liver transplantation have their own indications and limitations. Based on the precision surgical therapy, individualized selection of suitable surgical management on portal hypertension should be advocated to minimize invasiveness and cost effect ration, maximize organ saving and outcome. For patients with extrahepatic portal hypertension, Meso Rex bypass operation could be the preventive treatment method, surgical treatment could be applied to patients with regional portal hypertension.