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The article describes the features of the development of peritonitis ascites in patients with portal hypertension. Analyzed the medical histories of 650 patients who underwent surgery. Most often ascites developed peritonitis after gastrotomy stitching with esophageal varices and gastric done under urgent indications. Predisposing factor for the development of postoperative peritonitis ascites in patients with portal hypertension is gastroesophageal bleeding in the preoperative period. With postoperative ascites peritonitis in ascites dominated association of microorganisms and gram-negative rods. The most frequent symptoms at postoperative ascites peritonitis: low-grade temperature of the body, long-lasting postoperative intestinal paresis, the changing nature of ascites (the appearance of turbidity, flakes of fibrin). At present, many clinicians refuse to routine treatment of patients with portal hypertension, ascites and abdominal wall hernia, including its risky and unnecessary. This paper is based on the analysis of the results of surgical treatment of 47 patients with portal hypertension, abdominal wall hernia, and ascites. Defined indications for combined or combined treatment. Proved the need for an integrated approach and the possibility of successful treatment of these patients with satisfactory immediate and long-term results.