■ The position of the patient is important; a moderate reverse Trendelenberg position with the patient rolled slightly toward the right facilitates the exposure by dropping the pancreas and spleen away from the left hemidiaphragm and by dropping the left transverse and splenic flexure of the colon away from the operative field.
■ When easily accessible, the proximal splenic artery should be secured prior to completely mobilizing the pancreas and spleen from the retroperitoneum; this enables a rapid, secure, immediate hemostasis if the splenic capsule is torn during mobilization.
■ The splenic artery and vein are suture ligated and divided individually rather than securing both together with a mass ligature; this approach decreases the risk of postoperative splenic arteriovenous fistula.
■ Whenever possible, monofilament suture material rather than silk should be used to close the divided end of the pancreas. Monofilament, such as polypropylene, has a lower slip coefficient and can be pulled more easily (and potentially with less trauma) through tissue; monofilament lacks interstices and may be more resistant to infection than polyfilamentous sutures.
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