The spleen is attached by peritoneal reflections to multiple surrounding structures. These attachments must be successively divided to mobilize the spleen. The tail of the pancreas is usually within 1-2 cm of the lower end of the splenic hilum, where it is subject to injury in the course of splenectomy. Accessory spleens must be identified when doing splenectomy for hematologic conditions in which the spleen consumes formed blood elements.
The gastrosplenic ligament lies flat between the gastric surface of the spleen and the posterolateral gastric wall. Retracting the stomach to the right stretches the ligament for division. The splenorenal peritoneal reflection (ligament) lies inside the posterior lip of the spleen. The caudal end of this reflection, where division is begun, is exposed by mobilizing the splenic flexure. Blunt dissection of the splenorenal plane continues behind the tail of the pancreas. The same principles of mobilization apply in open or laparoscopic splenectomy.