The splenic vein is initially identified by a combination of palpation and vision. In an obese patient the vein may not be readily seen on the posterior surface of the pancreas, but it can always be felt. Initial dissection of the splenic vein is started where it is most easily seen or palpated. The goal is to mobilize all the overlying adventitia along the inferior and posterior surface of the splenic vein from the superior mesenteric vein to the splenic hilus.
The inferior mesenteric vein enters the splenic vein in 50% of patients and the superior mesenteric vein in the other 50 %. This is a useful landmark as it is always the first significant vein coming inferiorly as dissection proceeds from left to right. It should be ligated and interrupted.
The other key plane in this phase of the procedure is the posterior plane at the splenic superior mesenteric venous junction, as illustrated in the Figure. This is a safe plane to open with a finger or the tip of the sucker. The value of opening this plane is if any bleeding is encountered as the anterior dissection of the splenic vein is started, it can always be controlled by finger compression of the vessels.
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