WHIPPLE1 and Blakemore2 in 1943 began to restudy the problem of the surgical approach to the distressing complications of portal cirrhosis. Eck3 initiated the study in 1877 when he performed the first recorded successful anastomosis of the portal vein to the inferior vena cava. It remained for Blakemore,4 Whipple5 and later Blalock,6 Linton7 and others8 to devise varied shunts between the portal and caval systems and to perfect the technics of the procedures, as well as the indications for their use. The technical feasibility of such anastomoses, as well as the rationale for their choice, has been established. Because of the large stoma and the lessened chance for thrombus formation most authors favor the end to side portacaval shunt. The following communication describes the use in two cases of such an anastomosis, as well as the advantages of the right thoracoabdominal approach