Introduction: Surgical treatment for complication of portal biliopathy is an exception. It implies a high risk of bleeding given the prominent collaterals present in the hepatoduodenal pedicle secondary to portal cavernomatosis. Methods: Descriptive study of 4 patients who presented serious complications linked to portal biliopathy that required surgical management within the Clinical Hospital of Universidad Católica. Results: Woman 59 years, with necrohemorrhagic pancreatitis (1996), biliodigestive bypass (2001) and portal cavernomatosis (2004) was presenting repeated episodes of hemobilia, one with hypovolemic shock. A Warren's shunt was tried (2005), but it failed. Then, a choledochal devascularization and hepatic-jejunal re-anastomosis intervention was made. Man 57 years, with HIV positive and serious pancreatitis (2007), developed portal thrombosis post inflammatory and cavernomatosis and presented repeated cholangitis. Roux-en-Y reconstruction was made (2012). Woman 47 years, with V Leiden factor deficit and portal cavernomatosis (2012), presented repeated cholangitis. After multiple endoscopic stent treatments, given recurrence of cholangitis and jaundice, a Roux-en-Y biliary reconstruction was performed (2015). Man 47 years, with neonatal trombosis and cavernomatosis for omphalitis, had portal devascularization surgery made at 7 and 14 years old, he had repeated cholangitis despite multiple endoscopic attempts. Roux-en-Y was performed. All anastomosis was made in biliary conducts with multiple collateral veins that were handled with bipolar coagulation, ligatures and stiches. On the long term, none repeated episodes of hemobilia or cholangitis. Conclusion: The surgery could be a definite solution for portal biliopathy complications. However, it has only been made for selective cases because it implies high complexity and risk.