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DESCRIPTION
A Laparotomy is any surgical opening (incision) made into the abdomen to gain access into the abdominal cavity. It is also known as a coeliotomy.
DIAGNOSTIC LAPAROTOMY
In a diagnostic laparotomy, also referred to as an exploratory laparotomy) there is an examination of the abdominal organs to find and identify the cause of an unknown disease. The main reason for a laparotomy is to investigate abdominal pain. A surgeon may need to operate to find out the exact cause of a complaint such as pinpointing the cause of internal bleeding in the digestive tract or to find out where the bowel may be perforated, before treatment can commence.
Usually, only exploratory laparotomy is referred to as a surgical operation by itself, and when a specific operation is already planned, laparotomy is considered merely the first step of the procedure.
THERAPEUTIC LAPAROTOMY
In therapeutic laparotomy, a cause has been identified (such as a peptic ulcer or colon cancer) and a laparotomy is required for its therapy.
INCISION PLACEMENT
Depending on incision placement, it may give access to any abdominal organ or space, and is the first step in any major diagnostic or therapeutic surgical procedure of these organs, which include:
- The lower part of the digestive tract with the stomach, duodenum, small intestine (jejunum and ileum) and the large intestine (colon).
- The liver, pancreas, gallbladder and spleen.
- The bladder and ureters.
- The female reproductive organs involving the uterus, fallopian tubes and ovaries.
- The retroperitoneum with the kidneys, the aorta and abdominal lymph nodes.
TYPES OF LAPAROTOMY INCISIONS
The most common incision for laparotomy is the midline incision, a vertical incision which follows the linea alba. The upper midline incision usually extends from the xiphoid process to the umbilicus, while a typical lower midline incision is limited by the umbilicus superiorly and by the pubic symphysis inferiorly. Sometimes a single incision extending from xiphoid process to pubic symphysis is employed, especially in trauma surgery. Midline incisions are particularly favored in diagnostic laparotomy, as they allow wide access to most of the abdominal cavity.
Other common laparotomy incisions include:
- The Kocher (right subcostal) Incision (after Emil Theodor Kocher): This is appropriate for certain operations on the liver, gallbladder and biliary tract.
- The Davis or Rockey-Davis "Muscle-Splitting" Right Lower Quadrant Incision: appropriate for an Appendectomy.
- The Pfannenstiel Incision: A transverse incision below the umbilicus and just above the pubic symphysis. In the classic Pfannenstiel incision, the skin and subcutaneous tissue are incised transversally, but the linea alba is opened vertically. It is the incision of choice for Cesarean section and for abdominal hysterectomy for benign disease. A variation of this incision is the Maylard incision in which the rectus abdominis muscles are sectioned transversally to permit wider access to the pelvis.
- Lumbotomy: This consists of a lumbar incision which permits access to the kidneys (which are retroperitoneal) without entering the peritoneal cavity. It is typically used only for benign renal lesions.
Some problems found inside the abdomen can be easily diagnosed with ultrasound (such as gallstones) and imaging tests such as CT scans and x-rays, but many problems require surgery to obtain an accurate diagnosis.
RELATED PROCEDURES
A related procedure is laparoscopy, where cameras and other instruments are inserted into the peritoneal cavity via small holes in the abdomen. For example, an appendectomy can be done either by a laparotomy or by a laparoscopic approach.
As an alternative to laparotomy is laparoscopy (often referred to as "keyhole surgery") is used to examine the interior of the abdominal or pelvic cavity using a slender tube (laparoscope) inserted through a small incision. The laparoscope contains fibre-optic camera heads or surgical heads (or both). Before laparoscopy was available, health care providers had to routinely make large openings and cut through layers of tissue in order to examine internal organs. Laparoscopy greatly reduces the patient's recovery time.
MoonDragon's Obgyn Procedures: Laparoscopy
REASONS FOR PROCEDURE
REASONS FOR PERFORMING A LAPAROTOMY INCLUDE:
Collection of tissue samples for diagnosis.
Closure of hernias in the abdominal wall.
Repair or removal of abnormal tissue.
Removal of diseased organs.
Correction of unsightly or disfiguring abnormalities.
Abdominal exploration may be used to help diagnose many diseases and health problems, including:
- Inflammation of the appendix (acute appendicitis).
- Inflammation of the pancreas (acute or chronic pancreatitis).
- Pockets of infection (retroperitoneal abscess, abdominal abscess, pelvic abscess).
- Endometriosis.
- Inflammation of the fallopian tubes (salpingitis).
- Scar tissue in the abdomen (adhesions).
- Cancer of the ovary, colon, pancreas, liver.
- Inflammation of an intestinal pocket (diverticulitis).
- Hole in the intestine (intestinal perforation).
- Pregnancy outside of the uterus (ectopic pregnancy).
This surgery may also be used to determine the extent of certain cancers, such as Hodgkin's lymphoma.
RISK INCREASES WITH
Stress.
Obesity.
Smoking.
Excess alcohol consumption.
Poor nutrition.
Recent acute infection.
Chronic illness.
History of prior abdominal surgery, particularly if it occurred at the site of the current surgery.
Use of drugs such as antihypertensives; muscle relaxants; tranquilizers; sleep inducers; insulin; sedatives; beta-adrenergic blockers; cortisone.
Use of mind-altering drugs, including narcotics; psychedelics; hallucinogens; marijuana; sedatives; hypnotics; or cocaine.
DESCRIPTION OF PROCEDURE
BEFORE THE SURGERY
The health care provider or surgeon will ask about the patient's medical and surgical history, lifestyle factors (such as current medications) and any other factors that may have a bearing on the operation.
The surgical operation will be explained and discussed with the patient along with the possibility of any further surgery once the diagnosis is made. The patient will be informed about all pre-operative procedures and what to expect following the surgery. The patient will be asked to consent to the surgery.
Diagnostic tests, such as x-rays and blood tests may be performed.
THE SURGICAL PROCEDURE
The patient will be shaved in the abdominal region and given a surgical scrub lotion to use in the shower and a hospital gown to wear. An enema or some other form of bowel preparation may be used to empty the bowels.
An anesthesiologist will check the patient to see if they are fit for the operation and take note of any allergies the patient may have. The patient will have nothing to eat (nil by mouth) for a number of hours before the surgery. Usually one hour prior to the operation, the patient will be given a pre-medication injection to make them drowsy and help to dry up internal secretions.
A spinal, or more commonly, a general anesthesia is administered by injection and inhalation with an airway tube placed in the windpipe. An abdominal exploration (laparotomy) is done while you are under general anesthesia, which means you are asleep and feel no pain during the procedure.
An incision is made in the peritoneum (inner lining of the abdomen) is opened. The size and location of the surgical cut depends on the specific health issue.
Blood vessels cut during the surgery are clamped and tied.
Wound edges are retracted with a special instrument.
Fluid in the abdominal cavity is often removed for laboratory examination.
The abdominal organs are examined. Other surgeries may be performed at this time.
Samples of suspicious tissue are gathered (biopsy) or diseased areas are removed. An abdominal drainage tube may be inserted through the abdomen for a few days, depending on the surgery performed.
The peritoneum is closed, and the muscles are reconstructed with heavy sutures.
The skin is closed with sutures or clips, which usually can be removed about 3 to 7 days after surgery.
EXPECTED OUTCOME
The outcome from the surgery depends upon the findings. Expect complete healing without complications. Allow about 4 weeks for recovery from surgery.
POSSIBLE COMPLICATIONS
Excessive bleeding.
Complications related to the anesthesia such as problems breathing.
Reactions to medications.
Surgical wound infection.
Incisional hernia.
Abscess formation.
Injury to bowel, bladder, pelvic organs and blood vessels.
TREATMENT
GENERAL POST-SURGICAL MEASURES
IMMEDIATELY AFTER THE SURGERY - HOSPITAL CARE
The patient's temperature, pulse, respiration, blood pressure and wound site are carefully monitored.
The patient may have a drain inserted at the wound site.
A small tube may have been passed through the patient's nose and into their stomach to help drain stomach secretions for a day or two. This rests the digestive tract as it heals.
A urinary catheter is inserted to drain off urine. This should be removed a day or so following the surgery.
If the patient is on intravenous (IV) fluids, as they may not be allowed to eat for a few days. Usually, patients can resume normal eating and drinking about 2-3 days after the surgery.
Pain relief should be given regularly, as ordered by the health care provider, to keep the patient comfortable.
As soon as possible, the patient is encouraged to do deep breathing and leg exercises.
The patient is assisted out of bed the day after the operation (all going well). Early walking is important, as it reduces the risks of blood clots and chest infections.
The patient will have daily wound care and observation, and advice on caring for the wound at home.
Medication is given or prescribed to the patient on discharge.
The length of a patient's stay in the hospital depends on the severity of the underlying problem and their health insurance policy (unfortunately for some patients, they are sent home early if their policy doesn't allow extended convalescence... for these patients, it is important to arrange extra help at home until they are able to manage daily tasks).
AT-HOME CARE
Try to rest as much as possible for two weeks.
Arrangements should be made for family or friends to help the patient around the house. The patient needs to strictly avoid any heavy lifting, pulling or pushing.
The patient may need a modified diet following discharge from the hospital. Follow all dietary suggestions.
A hard ridge should form along the incision. As it heals, the ridge will recede gradually.
Use an electric heating pad, a heat lamp or a warm compress to relieve incisional pain.
Bathe and shower as usual. The patient may wash the incision gently with mild unscented soap.
Make sure the medications are taken and instructions followed precisely.
Move and elevate legs often while resting in bed to decrease the chance of deep-vein blood clots. Avoid standing for more than a few minutes at a time.
After two weeks, walk for 10 minutes every day, unless advised otherwise by the health care provider.
Report to the health care provider immediately if the wound becomes inflamed, tender, or starts to discharge. These symptoms could indicate an infection.
For some patients, recuperation time following laparotomy can take a few months, at least. As with any post-surgical procedure recovery, it is important to always consult with the health care provider and make sure to keep any follow-up appointments, especially the final check-up.
MEDICATION
Prescription pain medication should generally only be required for 2 to 7 days following the procedure.
You may use non-prescription drugs, such as acetaminophen or ibuprofen for minor pain.
Stool softener laxative, if needed to prevent constipation.
Antibiotics, if needed to fight infection.
ACTIVITY
To help recovery and aid your well-being, resume daily activities, including work, as soon as you are able.
Avoid lifting heavy objects and vigorous exercise for 6 weeks after surgery.
Resume driving about 3 weeks after returning home.
Sexual relations may be resumed when follow-up medical examination reveals complete healing.
DIET
Nasogastric suction is frequently required followed by a clear liquid diet until the gastrointestinal tract functions again. Then eat a well-balanced diet to promote healing. Another diet may be prescribed depending on any special condition.
NOTIFY YOUR HEALTH CARE PROVIDER IF...
Any of the following occurs:
- Swelling, pain, redness, drainage or bleeding increases in the surgical area.
- Signs of infection: headache, muscle aches, dizziness or a general ill feeling and fever.
- You experience new symptoms, such as nausea, vomiting, constipation, abdominal swelling or severe pain.
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