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