For a total splenectomy all vessels at the splenic hilus should be double ligated and transected.
For a partial splenectomy double ligate and incise hilar vessels supplying the area to be incised. Preserve the short gastric arteries supplying the gastric fundus where possible. Close excision with a continuous suture pattern.
Absorbable suture is usually used for splenectomy. Use synthetic monofilament for vessel ligation, particularly if generalized peritonitis is present.
MOST COMMON COMPLICATIONS AND DIFFICULTY
The most common complication of splenectomy is hemorrhage. Ensure that vessels have been properly ligated, and avoid cutting extremely close to ligatures to prevent their slipping off the vessel.
For total splenectomy, double ligate and transect all vessels at the splenic hilus. If possible, preserve the short gastric branches supplying the gastric fundus.
"EXPERTS' ADVICE"
Place ligatures on individual vessels near spleen, as opposed to ligating bundles of tissue incorporating vessels and fat.
Be sure to ligate the main splenic artery and vein separately to prevent an AV fistula at the ligature site.
Mass ligation of vessels is possible and may be necessary with neoplastic lesions. Ligate as close to the spleen as possible to avoid disrupting other vasculature.
Avoid ligating the short gastric vessels if possible.
The splenectomy can be performed by fewer ligations of the larger vessels using 2-0 to 0 strands of silk or by using multiple ligations along the hilus of the spleen using PDS* II, MONOCRYL* or Chromic Gut on a ligature reel.
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