Accesses: for elective splenectomy, the transverse upper abdominal laparotomy on the left is suitable. Alternatively, a left subcostal incision can also be performed.
In trauma, there is actually only one acceptable access to the abdomen and that is the median upper abdominal laparotomy. Only this access ensures sufficient overview of the entire abdomen.
In the presented contribution, the incision is predetermined by the previous laparotomy in the context of primary tumor resection.
The median laparotomy is carried from the xiphoid to caudal of the navel. Dividing the subcutaneous tissue and exposing the fascia. This is divided medially with the knife and the peritoneum is opened.
Tip: in coagulopathies, the division of a large abdominal wall muscle should be avoided, as massive bleeding can occur here!
First, a retractor system is inserted and the entire abdomen is inspected, exclusion of accessory spleens!
Tip: in the case of trauma, after opening the peritoneum, you will only see blood and have no overview at first. In particular, the source of bleeding is rarely recognizable at first glance initially. It is recommended to first pack all four quadrants with abdominal towels, instead of suctioning blood for minutes. In doing so, the surgeon can boldly reach behind the spleen with the left hand, luxate it ventrally, and place one to two abdominal towels in the splenic bed. In this way, the spleen becomes properly visible and assessable for the first time; the compression from dorsal reduces the bleeding.
In principle, the spleen can be mobilized from ventral or dorsal.The dorsal method is the standard for splenectomy, especially in emergency situations. The ventral method is sometimes better for very large spleens and for tumorous changes, as shown in the contribution. In principle, both approaches are possible and to be decided situationally. Often, it is unavoidable to switch back and forth between ventral and dorsal sides during preparation.