With the spleen retracted medially, the splenorenal ligament is incised over the kidney up toward the upper pole of the spleen. The short extension of this ligament above the kidney attaches to the diaphragm (splenophrenic ligament). In emergency splenectomy, this is the first maneuver after initial hemostasis. Some surgeons mobilize the spleen and tail of the pancreas in this way first routinely to bring the spleen up into the field for better access.
Once the spleen is mobilized, the hilar vessels are easily exposed posteriorly. The major vessels are isolated, ligated and divided individually. The tail of the pancreas is carefully separated from the lower part of the splenic hilum. The lesser sac and omentum are explored for accessory spleens, especially in hematologic conditions. The splenic bed is carefully checked for hemostasis and if dry, the abdomen is closed without drains.
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