STEP 8Completion of the anastomosis

Clamps are removed on completion of the anastomosis and the pancreas allowed to come down toward the left renal vein. A small amount of bleeding is usually controlled with some Surgicel and light packing for several minutes. Checking the position of this anastomosis is important to make sure there is no kinking or twisting of the splenic vein.

Completion of devascularization. The left gastric vein is identified if possible either as it joins the splenic vein or as it joins the portal vein. If it can be clipped at this site, it should be. It is also identified at the superior margin of the pancreas as shown in this figure and completely interrupted at this site.

Completion of the procedure at this point has now created a low pressure decompression of the spleen, gastric fundus, and distal esophagus, while maintaining portal hypertension and portal flow in the superior mesenteric and portal venous system.

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