The ligated short gastric vessels along the greater curve of the stomach are shown. There is invariably a gastric ileus following splenectomy, especially with the dissection necessary for a massive spleen such as this. Therefore, a nasogastric tube is left in place. Gastric dilatation poses the risk of both aspiration and disruption of ties on the short gastric vessels.
The splenic bed was carefully checked for hemostasis. No drain was left. The controversy of earlier times about leaving a drain after splenectomy centered on the risk of retrograde infection up an open drain vs. the benefit of draining blood oozing from the raw surfaces, which is a good bacterial culture medium. In the present era of perioperative antibiotics and closed suction drains, a drain might be left only in the face of a severe coagulopathy and poorly-controlled oozing.
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