Use a midline incision, which is optimal for exposure when the spleen is ruptured or massively enlarged.
Understand that a left costal margin incision is preferred in most elective procedures.
Mobilize the spleen by dividing ligamentous attachments, beginning with the splenocolic ligament.
Enter the lesser sac.
Realize that in patients with significant splenomegaly, early ligation of the splenic artery along the superior border of the pancreas is an option and may be preferred.
This allows safer manipulation of the spleen and dissection of the hilum.
This allows for some shrinkage of the spleen itself.
This provides an autotransfusion of red blood cells and platelets.
Incise the lateral peritoneal attachments, most importantly the splenophrenic ligament, and gently develop a plane deep to the spleen and tail of the pancreas.
Next perform individual ligation and sequential division of the short gastric vessels.
Identify the tail of the pancreas and protect it from harm. The tail of the pancreas often lies within 1 cm of the splenic hilum.
Ligate the splenic artery and vein before dividing them.
Remove the spleen.
Look for accessory spleens. Common locations are the splenic hilum, splenic pedicle, greater omentum, the tail of the pancreas, and splenocolic ligaments.
Close the abdomen without drainage.
Educational aid only. Verify every dose, indication, and guideline against current institutional protocol. This is not a substitute for clinical judgment.
