since 1984 , in an attempt to maintain at least part of the splenic function when the removal of the spleen is recommended , we have performed subtotal splenectomies , preserving the superior splenic pole supplied by the splenogastric vessels . this procedure was successfully used for the treatment of 130 patients with portal hypertension , 93 patients with severe splenic trauma , 18 patients with myeloid metaplasia , nine patients with gaucher s disease , five patients with retarded growth and sexual development associated with splenomegaly , five patients with chronic lymphocytic leukemia , three patients with severe splenic pain due to intraparenchymal thrombosis , one patient with splenic hemangioma , one patient with splenic abscess , and one patient with a cystadenoma of the pancreatic tail , , , , , , , , , , , , , , . splenectomy has a very limited role in the treatment of hodgkin s lymphoma ( hl ) and is recommended only to control hl activity that does not respond to chemo- and radiotherapy , . since the purpose of a splenectomy is not to make the patient asplenic , a partial splenectomy may achieve the objectives without the adverse side effects of the total removal of the spleen , , . this is the first report of subtotal splenectomy preserving the inferior splenic pole without the maintenance of the splenic vascular pedicle . the treatment performed on this patient was approved by the ethical committee of the federal university of minas gerais under the protocol nr . caae 03990.203.000 - 11 and has been performed in accordance with the ethical standards laid down in the 1964 declaration of helsinki and its later amendments . this work has been reported in line with the scare criteria . a 53-year - old white man with hl was submitted to chemotherapy and radiotherapy at hospital of clinics of the federal university of minas gerais , brazil and referred to the department of surgery for splenectomy . the indications for spleen removal were abdominal and breathing discomfort caused by a huge spleen due to hl refractory to adjuvant oncologic therapy . to avoid surgical induced asplenic immune depression , the abdominal cavity was entered through a left transverse laparotomy ; the splenic artery was tied in the retrogastric space . at laparotomy , a very large spleen with a tumor restricted to the superior pole was found ( fig . the superior splenic vessels , including the splenogastric vessels , the superior splenic pole vessels and the splenic hilum were tied and cut . care was taken to preserve the left gastroepiploic and the inferior splenic pole vessels to maintain the vitality of the inferior splenic pole . the spleen was cut at the dividing line between the normal color of the inferior portion of the organ and the darker colored superior portion ( fig . two wide flaps ( anterior and posterior ) of the 5 splenic capsule were retained . a continuous 3 - 0 chromic catgut suture closed the two flaps of the splenic capsule ( fig . the inferior pole was returned to its normal position and sutured to the diaphragm with one stitch using 2 - 0 chromic catgut . 1surgical view of subtotal splenectomy for treatment of a man with hodgkin s lymphoma.a the very large spleen mobilized within the surgical field after the section of the splenic ligaments . observe the tumor in the superior pole ( * ) and the transition ( arrow ) between the inferior pole ( red ) supplied by the left gastroepiploic and inferior pole vessels and the rest of the devascularized spleen ( dark color).b  the inferior splenic pole ( * ) after subtotal splenectomy . observe the left gastroepiploic vessels ( long thin arrow ) inside the grater omentum , and the inferior pole vessels ( short thick arrow).fig . 1 surgical view of subtotal splenectomy for treatment of a man with hodgkin s lymphoma . a the very large spleen mobilized within the surgical field after the section of the splenic ligaments . observe the tumor in the superior pole ( * ) and the transition ( arrow ) between the inferior pole ( red ) supplied by the left gastroepiploic and inferior pole vessels and the rest of the devascularized spleen ( dark color ) . b  the inferior splenic pole ( * ) after subtotal splenectomy . observe the left gastroepiploic vessels ( long thin arrow ) inside the grater omentum , and the inferior pole vessels ( short thick arrow ) . histopathological analyses of the spleen confirmed the hl restricted to the superior pole with wide margins free of tumor . the patient had uneventful postoperative recovery and was discharged from the hospital on the fifth postoperative day . during the eleven - year follow - up scintigraphic images of the splenic remnant were positive in all postoperative exams , confirming the splenic vitality and the phagocytic function . the dimensions of the splenic remnant , according to ct exams , remained unchanged during the follow - up period ( table 1).table 1hematological exams one week before and three months after subtotal splenectomy to treat hodgkin s g / l141  g / lhematocrit36.0%42.5%  white blood cells  total3.6    10/l12.4    10/l  neutrophils61%78%  lymphocytes31%17%  eosinophils1%0%  basophils1%0%  monocytes6%5%  platelets78    10/l478    10/l hematological exams one week before and three months after subtotal splenectomy to treat hodgkin s lymphoma . chemo- and radiotherapy are the usual treatments of hl , and most of patients survive many years under control , . however , the huge growth of the spleen , which may occur in some patients , leads to abdominal discomfort and therapeutic resistance . it is well - known that total splenectomy reduces the immune defenses and may be followed by severe sepsis associated with precocious and sudden deaths . this complication is more frequent in previously immune suppressed patients , such as those with lymphomas , . chemo- and radiotherapy worsen organic defenses and enhance mortality . since the total removal of the spleen is not necessary to treat hl , partial splenectomy should be enough to reduce the influence of splenic growth on both the symptoms and the hematologic system , . however , the early good results are transitory , given that the spleen may regrow due to the blood flow through the splenic vascular pedicle . to avoid this inconvenient follow - up , we have proposed the subtotal splenectomy , which preserves a pole of the spleen without the vascular pedicle . usually , the subtotal splenectomy maintains only the superior pole supplied by the splenogastric vessels , but in this case , the tumor was located in the superior pole and had to be removed . therefore , we decided to perform the subtotal splenectomy , preserving the inferior splenic pole supplied by the left gastroepiploic vessels . prior to the present case report , the use of this technique had never been published . thus , we decided to follow the patient a least for ten years before publishing the case to detect all complications of this procedure when in the presence of hl . its main advantage is to preserve the splenic functions in a normal size spleen without the risk of its regrowth and resistance to oncologic treatment . as limitation of this study , the lower number of patients with hl confined to a single pole must be emphasized . this procedure should not be attempted for staging purpose in hl because the disease may be present in the preserved spleen even without its macroscopic evidence . a subtotal splenectomy that preserves the inferior splenic pole is efficacious in maintaining splenic functions and preventing the adverse effects of a large spleen in the treatment of hodgkin s lymphoma confined to superior pole and producing significant abdominal symptoms and hematological effects . the treatment performed on this patient was approved by the ethical committee of the federal university of minas gerais under the protocol nr . informed consent was obtained from the patient in written for the surgical procedure and for publication of his case with picture of the splenic procedure . informed consent was obtained from the patient in written for the surgical procedure and for publication of his case with picture of the splenic procedure revision of the literature , proposal of the surgical procedure , surgeon who performed the procedure , surgeon responsible for the patient during the perioperative period and all the follow - up , author who wrote the manuscript . i accept full responsibility for the work and/or the conduct of the study , had access to the data , and controlled the decision to publish .