A portosystemic shunt is an erroneous venous communication between the portal vein and the systemiccirculation. Surgery is the treatment of choice. Progressive attenuation of the shunt is indicated in mostcases to prevent portal hypertension. Gauged attenuation using silk was the first method used. Differentmethods are used to estimate the degree of closure that can be tolerated by the patient and will not causeportal hypertension, but they are time-consuming and not always equally reliable. If only partial closure ispossible, a second surgery may be needed. Gradual attenuation can be achieved using an ameroid constrictor(AC), cellophane banding (CB), a hydraulic occluder or thrombogenic coils. There is great interpatientvariability between the rate and degree of shunt closure when using an ameroid constrictor or cellophanebanding. Thrombogenic coils and hydraulic occluders appear to give a more controlled shunt closure, butfurther investigation is needed.