In elective splenectomy where immediate control of the pedicle is not urgent, the gastrosplenic ligament can be divided first, starting from the gastrocolic ligament at the lower pole of the spleen. By retracting the stomach medially, the gastrocolic ligament is stretched and may be sequentially ligated and divided.
The lower pole end of the ligament is broader than the upper pole end and division of the highest short gastric vessels becomes progressively more difficult. Care is taken to doubly ligate or suture ligate the gastric side of the short gastric vessels. The invariable gastric atony postoperatively can cause gastric dilatation if the nasogastric tube becomes blocked and the gastric ties can be dislodged.
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