A left gastric venacaval shunt for esophageal varices was performed in six patients in attempts to selectively decrease left gastric venous pressure without decreasing portal venous pressure. The left gastric venous pressure decreased from 140-390 mmH2O to 140-200 mmH2O after the left gastric venacaval shunt, while the portal venous pressure remained at 140-370 mmH2O, postoperatively. Even when the portal venous pressure increased up to 320-400 mmH2O with a temporary occlusion of the portal vein, there were no significant changes in the left gastric venous pressure. Five patients are doing well, one to 36 months postoperatively. One patient died of hepatic failure with bleeding on the 21st postoperative day. The left gastric venacaval shunt decreased the incidence of rebleeding and prevented postoperative hepatoencephalopathy and hepatic failure.