Plate 123
###### Figure 23

The tail and body of the pancreas, now freely mobilized, are rotated toward the midline so that the courses of the splenic artery and vein are clearly visualized (Figure 18). The splenic artery should be doubly ligated and divided near its point of origin. It is advisable to remove the artery from this point of ligature out to the tip of the pancreas. Likewise, the splenic vein should be carefully dissected free of the adjacent pancreas and doubly ligated very near its junction with the inferior mesenteric vein (Figure 18). After the artery and vein have been removed from the distal half of the pancreas, the tail of the pancreas is stabilized with a suture or Allis forceps, and the end of the pancreas is transected carefully until the pancreatic duct is identified (Figure 19). The small amount of bleeding that occurs can be controlled easily by compressing the pancreas between the thumb and index finger, clamping the individual bleeding points, and then ligating them with 0000 silk (Figure 19). As soon as the pancreatic duct is located, a probe is inserted into the duct (Figure 20). The duct is usually a little nearer to the superior than to the inferior margin of the pancreas. The surgeon then grasps the pancreas with the thumb and index finger and makes an incision directly down onto the probe, completely exteriorizing the major pancreatic duct (Figure 21). The incision should be carried medially, and soon the pancreatic duct will greatly enlarge. With intermittent strictures and dilatations, there is a tendency of the duct to form a chain of individual lakes. Multiple calculi may be encountered and small calcifications noted in many small ducts within the wall of the fibrosed pancreas. The incision is carried from the tail of the pancreas downward as near as possible to the medial border of the duodenum (Figure 22). This is accomplished by stabilizing the pancreas with the left hand and inserting scissors into the lumen of the duct and carrying the dissection medially (Figure 22). The finger is inserted into the enlarged proximal portion of the dilated duct, and any calculi are removed. A small probe may be introduced into this area to determine whether or not there is free ...

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