The authors discuss the importance of portosystemic anastomoses in contemporary treatment of portal hypertension, in particular in relation to TIPS. As a basis they use their own experience with 28 portosystemic anastomoses during the last five years and conclude that a correctly indicated anastomosis has certain advantages over TIPS. The basic requirements for indication of surgical peripheral portosystemic anastomoses are: 1. stage Child A (or onset of B), 2. posthaemorrhagic conditions, 3. satisfactory general condition, 4. stabilized liver disease and planned surgery.