There are two core problems faced by patients with portal hypertension: one is bleeding from ruptured esophagogastric fundic varices; the other is abdominal compression symptoms and significant leukocyte and platelet lowering due to splenomegaly and hypersplenism. All of the clinician’s approaches are centered on helping the patient with these two problems. The surgical approach to portal hypertension addresses these two problems by performing a peripancreatic vascular dissection, which dissects the peripancreatic vessels causing the patient to form a shunt for rupture and bleeding of the esophageal fundal varices, allowing the varices to resolve and reducing the risk of rupture and bleeding of the esophageal fundal varices. Perform splenectomy (partial) to solve the problem of splenomegaly and hypersplenism, relieve the abdominal compression symptoms caused by the huge spleen, and allow white blood cells and platelets to return to normal. Compared with other modalities for the treatment of portal hypertension, splenectomy is a more comprehensive solution to the problem, reducing the risk of bleeding and resolving hypersplenism in terms of effectiveness. As far as safety is concerned, there is almost no risk of further deterioration of hepatic encephalopathy or liver function due to the procedure. In recent years, partial splenectomy with interruption of flow has been developed on the basis of the traditional total splenectomy with interruption of flow. Compared with the traditional operation, due to the preservation of part of the spleen and its blood vessels, in addition to preserving part of the function of the spleen, it also greatly reduces the chances of thrombosis in the portal system, and the portal system of some patients can be restored to the normal structure of the portal system a few months after the operation. Partial splenectomy has a certain degree of surgical difficulty, and there are certain technical points and technical requirements in order to achieve safe removal of part of the spleen and avoid intraoperative hemorrhage. Moreover, an individualized surgical strategy is required based on the vascular distribution characteristics of the spleen. Partial splenectomy routinely involves the removal of some lobules from the lower pole of the spleen, which is relatively simple and less risky. However, in some patients, due to the special distribution of blood vessels in the splenic hilum, the free portion of blood vessels in the lower pole of the spleen is short and compact, which is not easy to be separated, and easy to bleed during the operation, making it extremely difficult to retain the lower pole of the spleen. If these patients want to have part of the spleen removed successfully, the upper pole of the spleen should be considered. However, due to the special location of the upper pole of the spleen and the connection of blood vessels and ligaments with the fundus of the stomach and the retroperitoneum, it is very difficult to perform surgery, and the risk of intraoperative bleeding is also high. It is somewhat similar to caudate lobectomy in liver resection. In order to perform a safe partial resection of the upper pole of the spleen, targeted surgical measures must be taken in conjunction with the characteristics of the patient’s vascular distribution to ensure a safe cut of the splenic portion. The more one disposes of a class of disease, the more variations one sees. Some patients with individual anatomical variations cannot apply conventional or even so-called standardized surgical procedures, and need to take targeted surgical solutions in combination with the patient’s individualized characteristics in order to solve the patient’s problems. This is the essence of individualization, the response is also the clinician’s grasp of the nature of the disease. The more you see, the more changes you see. In the routine and changes in the constant comparison of the essence of the disease characteristics of more and more in-depth understanding, it is possible to adapt to all changes, all changes are not the same.