I have previously published an article on the need to remove the spleen in cirrhosis with splenomegaly. Thank you very much for your interest and many patients have been inquiring recently through outpatient clinics and Twitter, etc. Due to a change in workplace, I have come into contact with more patients who need to address hypersplenism and esophagogastric fundic varices. Naturally, there have been many questions about whether surgery or minimally invasive treatment such as intervention is better. There is also a considerable debate among doctors. Based on the intensive contact in the past year combined with my previous experience and review of relevant domestic and foreign research results, I would like to update some of my knowledge in this area and briefly list a few principles and recommendations: 1, all these problems are caused by cirrhosis, this is the cause, all others are the effect, treatment should be both the symptoms and the root cause, so when hypersplenism and varices reach a level that requires treatment, liver transplantation is the most effective 2, no liver transplantation conditions (after all, the price is very expensive, donor liver is very scarce), surgical removal of the spleen, intervention, gastroscopic ligation treatment becomes necessary. Just as the pants are torn, there are conditions for a new one, no conditions for a patch to wear again for a while. 3. How to choose these treatments. My understanding is that for patients who are sure not to do transplantation and have no intention to do so in the future, if the hypersplenism is really severe, combined with a history of upper gastrointestinal bleeding or a high risk of bleeding, surgical removal of the spleen and vascular dissection are recommended. If you intend to do transplantation in the future, do not do surgical resection because it may lead to portal vein thrombosis or portal vein spongiosis, which may affect transplantation. 4. For splenomegaly, interventional treatment of hypersplenism requires caution because it can have serious side effects, such as persistent high fever and severe abdominal pain, and create great difficulties and risks for possible future surgical resection. In addition, the effect of interventional splenic embolization is not certain. Short-term white blood cells and platelets can rise, but they cannot last. Therefore, interventions may be considered for patients who need a short-term increase in platelets and white blood cells to qualify for other surgical procedures or interferon therapy, and who do not wish to have their spleen removed. Otherwise, intervention is not recommended as the first choice (this is some difference with my previous understanding). 5.For patients with esophagogastric fundic varices, in order to prevent or control upper gastrointestinal bleeding, surgery, gastroscopic ligation, TIPS (stent implantation) and other treatments can be considered, depending on the patient’s wishes and the technical conditions of the doctors in the hospital to decide which treatment to choose. 6.For the view that splenectomy can improve cirrhosis, I checked the relevant information and combined with my own experience, there is no clear confirmation of this statement. I am also following the related content and will share if there is a clear conclusion in the future. At least for now, it cannot be used as a one-time purpose to remove the spleen. These are some of the latest understandings, which may be different from the original article. In itself, the understanding of many issues is constantly progressing and updating, and I hope to keep sharing them with you, so that the progress of medicine and individual doctors can promote the continuous improvement of medical standards. Welcome criticism and correction.