A special type of portal hypertension is patients with isolated varicose veins in the fundus combined with gastrorenal shunts. In these patients, there is an isolated varicose vein mass in the fundus that is prone to rupture and bleeding, resulting in repeated vomiting of blood and black stools. There is a shunt channel between the isolated venous mass in the fundus and the left renal vein, along which some of the patient’s blood from the portal venous system passes directly into the vena cava system through the left renal vein. Once this type of patient bleeds, it is more difficult to treat. One is that these patients cannot be treated with endoscopic tissue glue like other patients with ruptured fundic varices because of the risk of tissue glue entering the vena cava circulation and forming an ectopic embolism, which could kill the patient in minutes if a pulmonary embolism is formed. Second, these patients are also not well suited for TIPS treatment, which creates another shunt between the portal and vena cava in the liver, and has no therapeutic effect on the naturally formed gastric-renal shunt and risks hepatic encephalopathy. Therefore, the treatment options for this group of patients are very limited and often the only solution for the patient is surgical treatment. The treatment of this type of disease can especially reflect the superiority of surgery, because only surgery can completely disconnect the patient’s gastric-renal shunt channel and release the isolated varicose veins in the fundus, and the surgical effect is immediate and long-lasting, without the hidden danger of varicose veins and varicose recurrence. The picture below shows a patient with recurrent vomiting of blood and black stool who visited our hospital and was found to have isolated varicose veins in the fundus, gastric-renal shunt, and an enlarged spleen with no obvious hypersplenism. The preoperative diagnosis was portal hypertension combined with isolated varicose veins in the fundus and gastric-renal shunt. In order to reduce the risk of bleeding from ruptured varices in the fundus, isolated varices in the fundus and gastric-renal shunts were dissected, and postoperative review of enhanced CT showed that the isolated varices in the fundus and gastric-renal shunts had completely disappeared. The patient’s spleen was slightly enlarged and there was no obvious hypersplenism, so (partial) splenectomy was not performed intraoperatively. The development and implementation of the surgical plan was completely based on the patient’s anatomical features, very individualized and well targeted, with excellent surgical results. The surgical procedure for any disease is standardized and advocated by expert professors on the basis of extensive practice. The purpose is to solve the essential problems of the patient based on the common features of the disease and to improve the efficacy and safety of the surgery. However, any surgeon in a large number of practices over the years will always find differences in the same disease in different individuals, some with obvious anatomical abnormalities. For such patients, the surgical procedure needs to be individualized with the patient’s specific situation in order to fundamentally solve the patient’s problem. The basis of standardization is the common characteristics of the disease, and individualized treatment reflects the doctor’s grasp of the nature of the disease.