A splenectomy is a surgical operation involving the removal of the spleen (1). Naturally the anatomy of the spleen is of great importance for the surgeon to perform the splenectomy successfully. The spleen is an ovoid, usually purplish, pulpy mass about the size of one’s fist (2). It is located in the superolateral part of the left upper quadrant or hypochondrium of the abdomen where it is protected by the inferior thoracic cage (2). The spleen also lies in relation to the 9th, 10th and 11th ribs (3).
Figure 1: The anatomical position of the spleen in the human body (4).
All patients undergoing elective splenectomy should be vaccinated at least 1 week preoperatively ...view middle of the document...
Great care must be taken during splenic hilar dissection to avoid injuring the tail of the pancreas (7).
Drains are not routinely used (as they may increase the incidence of subphrenic sepsis), unless there is a possibility that the tail of the pancreas has been injured or there is persistent oozing due to a coagulation defect (6).
Figure 2: Splenocolic ligament is divided at the beginning of open splenectomy (5).
Laparoscopic splenectomy is now preferred by many surgeons (5). An ever-increasing amount of research confirms the benefit of a laparoscopic splenectomy for a growing number of patient groups: patients with splenomegaly, those with multiple previous abdominal operations, morbidly obese patients and those who need concomitant procedures (5). Firstly, the patient is positioned in a right lateral decubitus position with a reverse Trendelenberg tilt; which facilitates mobilization (6). An epigastric midline cut down with insertion of a blunt port, is followed by left subcostal dissection ports triangulating on the splenic hilum (7).
Figure 3: Patient positioning for laparoscopic splenectomy (5).
The splenic flexure is mobilized to expose the inferior pole of the spleen; access to the short gastric vessels can be facilitated by leaving the diaphragmatic attachments intact (5). The stomach will fall away from the spleen on division of the short gastric vessels (5)....