[Difficult splenectomies. Usefulness of pancreatic tail mobilization for initial ligature of splenic vessels (author's transl)].

Splenectomy may be difficult when the spleen is deep-seated, with a short and wide pedicle, or when it is associated with portal hypertension and immobilized by epiploic or peritoneal adhesions. In such cases the conventional technique of splenectomy, even with initial ligature of the splenic artery along the superior border of the pancreas, may be insufficient to prevent hazardous bleeding. Mobilisation of the pancreatic tail in the posterior mesogastrium is recommended, as it gives access to the splenic vessels in the hilum, where they can be isolated and ligated prior to splenectomy.