Nothing may be more difficult than the exposure and control of the vessels in the pedicle of an enlarged or adherent spleen; the application of clamps or ligatures is often very uncertain; if hemorrhage does occur, it may be impossible to check it completely until after the spleen has been removed.
I believe that ligation (either temporary or permanent) of the arterial supply of the spleen at certain points which are more accessible than the deeply situated splenic pedicle will greatly facilitate matters in difficult splenectomies. These points are (1) the splenic artery close to the celiac axis, and (2) the gastroepiploica sinistra where it reaches the stomach wall from the splenic artery.
The celiac axis is readily exposed through an opening in the lesser omentum just above the lesser curvature of the stomach; (it may be made to come within an inch or so of the anterior abdominal wall
GERSTER JCA. LIGATION OF THE SPLENIC AND GASTROEPIPLOICA SINISTRA ARTERIES IN THE SURGERY OF THE SPLEEN. JAMA. 1915;LXV(6):527. doi:10.1001/jama.1915.02580060059020
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