STEP 2Isolation of the spleen

The splenectomy in the setting of portal hypertension is often the most challenging part of the procedure. The vessels along the large gastric curvature are divided to expose the short gastric vessels, which are isolated and separated. Then the posterior adhesions of the spleen are divided. Afterwards the left colon flexure is retracted downwards and the adhesions between colon and spleen are divided (A).

The hilus of the spleen is isolated and the splenic artery and vein are identified whenever possible. The hilar structures are clamped with large Kelly clamps, divided and suture-ligated. Removal of the enlarged spleen results in more space in the left upper abdomen and often facilitates the further preparation of the stomach and the esophagus (B).

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