A surgical porto-systemic shunt was carried out in 37 children and adolescents (age: 2 yrs-18 yrs) who presented with cirrhosis and portal hypertension. All patients were classified "A" or "B" according to Child's criteria. Proof of the patency of the shunt was obtained by endoscopy and/or angiography in 31 children. Two children died in the early postoperative period. Thrombosis of the shunt occurred in 4 children. With a follow-up of 6 months to 11 years, none of the 31 children operated on successfully presented with gastro-intestinal bleeding due to portal hypertension. Nine presented with one or several episodes of porto-systemic encephalopathy. Five of these were transient allowing for a normal diet to be resumed later. These results indicate that porto-systemic shunts are effective to prevent gastro-intestinal bleeding, even in young children with cirrhosis. However, in addition to Child's criteria, indications for shunt surgery must take into account the degree of hemorrhage risk and the possible need for a liver transplantation later.