Section 6.8 – Mobilisation of posterior wall of upper region
Once the small bowel mesentery, left mesocolon and mesoduodenum have been detached
It is possible to bluntly dissect under the dorsal mesogastrium
This is achieved by raising the mesentery off the fascia
Then separating the mesentery from underlying fascia by blunt and sharp dissection
With this combination of dissection, the dorsal mesogastrium is detached enough
To enable the dissector insert a hand, under the dorsal mesogastrium
The dissector can then blindly detach the overlying mesogastrium, from underlying fascia
As far proximally as the OG junction,
This process enables detachment of most of the mesogastrium
Disconnection requires division of the lienophrenic region of the peritoneal reflection
The reflection is exposed by lifting the spleen away from the posterior abdominal wall
This places the reflection under stretch, enabling its visualisation and sharp division
Once identified the lienophrenic reflection can be further divided
Enabling medial mobilisation of the dorsal mesogastrium
Division of the reflection is continued up and around to the OG junction
Thereby further detaching the spleen and continuous mesogastrium
The medial region of the dorsal mesogastrium can then be further detached by blunt dissection
The dorsal mesogastrium and spleen are then retracted to the right by the assistant
An the dissector, standing to the left, separates the dorsal mesogastrium to the midline