ABSTRACT
Trauma patients requiring splenectomy should receive these immunizations after recovering from the splenectomy. When removing the spleen for a hematologic disorder, a right upper quadrant ultrasound noting gallstones prompts a cholecystectomy at the time of splenectomy. An open midline incision allows inspection of the remainder of the abdomen while providing excellent exposure for splenectomy. To gain vascular exposure, rapid division of the ligamentous attachments allows mobilization of the spleen out of the abdomen. The open operation involves either an upper midline incision or a left upper quadrant incision with the patient supine, or a left upper quadrant incision with the patient in the right lateral decubitus position (which is the authors’ preferred exposure for an open elective splenectomy). Partial splenectomy attempts to retain 10–15% of the splenic volume on its vascular pedicle to help prevent postoperative sequelae of a total splenectomy. The operation mimics a total laparoscopic splenectomy with the same patient positioning.
