William D. Holden, M.D., ClevelandThe principal hazard encountered in performing a splenectomy is hemorrhage. The operative procedure may be relatively simple or it may tax the patients and ingenuity of the surgeon to the utmost.The type of incision is of great importance in facilitating technical maneuvers during the operation. The left paramedian incision (Plate IA) extending upward to the vicinity of the xiphoid process provides better exposure than either a transverse or subcostal incision (Plate IB). This extension is especially worth while because the densest peritoneal attachments of the spleen to the posterior parietal peritoneum are frequently at the upper pole. The gastrosplenic ligament can also be exposed and clamped most easily when the incision is extended upward as far as possible. When a splenorenal anastomosis is anticipated and considerable portacaval collateral channels exist, a combined thoracoabdominal incision (Plate IB) provides better exposure
MADDEN JL. Splenectomy. AMA Arch Surg. 1957;74(4):635–641. doi:10.1001/archsurg.1957.01280100153027
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