OBJECTIVE: To summarize the results of pediatric pulse hypertension treated with preserved spleen and distal splenic vein-renal vein bypass surgery (Warren procedure) over the past 8 years. METHODS: There were 36 children in this group, aged 3 to 15 years. There were 12 male cases and 24 female cases. The children presented with recurrent gastrointestinal bleeding, esophageal varices, and hypersplenism. The diameter of the splenic vein ranged from 6.5 to 12.2 mm, with a mean of (8.6±2.3) mm. Then the entire splenic vein was dissected at 0.5 cm from the superior mesenteric vein and anastomosed with the left renal vein on the terminal side. RESULTS: In 36 children with distal splenic-renal shunts, the average operative time was 3.1 h, and the operative blood loss was 10-30 ml; no intraoperative transfusion was required. The superior mesenteric vein pressure before shunt was 26.5-33.3 cmH2O, with a mean value of (28.9±4.8) cmH2O; the splenic vein pressure was 26.2-33.5 cmH2O, with a mean value of (28.5±4.5) cmH2O; the superior mesenteric vein pressure after shunt was 17.2-26.4 cmH2O, with a mean value of (23.8±3.9) cmH2O. cmH2O and splenic vein pressure was 10.5-16.1 cmH2O, with a mean value of (13.5±4.7) cmH2O, and splenic vein pressure was significantly lower after shunt surgery (P<0.01)< span="">. Two children developed celiac disease after surgery, which disappeared spontaneously after 1 month of conservative treatment. During the follow-up period of 6-94 months, one case (1/36) had anastomotic closure 3 months after surgery, splenectomy and flow dissection. The other 35 cases had no recurrent gastrointestinal bleeding during the follow-up period, and the spleen, although slightly larger than normal for children of the same age, was retracted and the hemoglobin, white blood cells, and platelets were at normal levels, and there were no cases of encephalopathy. ultrasound examination showed that the splenorenal vein anastomosis was patent. Conclusion: Warren procedure is one of the effective ways to treat pediatric extrahepatic portal hypertension, with reliable results in preventing gastrointestinal rebleeding and hypersplenism, and also has the advantages of preserving the spleen and allowing blood flow from the cardia fundus to the splenic vein through the short gastric artery to keep the region at low pressure without reducing portal perfusion pressure.