What is a laparotomy?
A laparotomy is the medical term for a surgical opening of the abdominal cavity. It allows the surgeon access to the abdominal organs during operations – for example, if an organ is diseased or injured. The abdominal incision can also help to find the cause of unclear complaints in the abdominal region. In this case, it is called an exploratory laparotomy. According to the type and direction in which the incision is made, a distinction is made between:
- paramedian laparotomy (incision in the longitudinal direction lateral to the midline
- subcostal laparotomy (incision along the course of the lower rib on the left or right side)
- transverse laparotomy (abdominal incision made transversely from left to right in the upper or middle abdomen)
- Alternate incision (shorter diagonal incision in the right lower abdomen)
- acetabular pedicle incision (transverse=horizontal incision across the midline in the lower abdomen
When do you perform a laparotomy?
Laparotomy is a common access route for major abdominal surgery. For example, the abdominal incision is used in the following situations:
- cancer of an abdominal organ
- inflammatory disease in the abdominal cavity
- transplantation of abdominal organs such as liver, kidney or pancreas
- Delivery by cesarean section.
Explorative laparotomy
What is done during a laparotomy?
Below the costal arches, the abdominal wall extends to the pubic bone. Seen from the outside, it consists of the skin, a layer of fat and the anterior, lateral and posterior abdominal muscles. Below this is the connective tissue covering of the abdominal cavity and the peritoneum. The stomach, intestines, liver, gallbladder, pancreas, spleen, urinary bladder, as well as the internal reproductive organs in the pelvic ring are located in the abdominal cavity.
Before the operation
Median laparotomy
If the surgeon chooses the median laparotomy as the access route, he or she makes an elongated abdominal incision exactly in the middle of the abdomen. This usually involves making an incision around the belly button on the left side. If necessary, the surgeon can extend this incision upward to the breastbone and downward to the pubic bone. This gives him optimal access to all organs in the abdominal cavity. Almost all abdominal surgical procedures can be performed via a median laparotomy.
In the paramedian construction incision, as in the median laparotomy, a longitudinal incision is made. This runs approximately one transverse finger next to the midline of the abdomen or along the outer edge of the straight abdominal muscle.
Ribcage margin incision
Transverse laparotomy
The transverse abdominal incision can be used in the upper, middle and lower abdomen. It can be made on one side, but can also be extended to the opposite side if necessary. Transverse abdominal incisions are chosen primarily for procedures where the surgical goal is clear – i.e., not necessarily for exploratory laparotomy.
Alternate incision
Pfannenstiel incision
The acetabular pedicle incision refers to an approximately eight to twelve centimeter long transverse incision just above the pubic bone. Since the surgeon can thus see the female internal genital organs particularly well, the acetabular pedicle incision is a common technique in gynecological surgery.
Flank incision
After the operation
After the anesthesia is completed, the anesthesiologist (anesthesiologist) takes the patient to the recovery room so that the patient can recover from the anesthesia under intensive observation.
What are the risks of laparotomy?
As with any surgery, problems can occur during a laparotomy. The most common are:
- Bleeding and rebleeding, possibly requiring a blood transfusion or, in the case of major rebleeding, a repeat procedure.
- Injury to nerves
- Infections and inflammations
- Wound healing disorders
- Excessive or cosmetically conspicuous scarring
- Scar hernias
Other possible complications, such as injury to an organ, depend on the specific abdominal surgery.
What do I need to be aware of after a laparotomy?
In addition, the wound in the area of the suture is initially sensitive to touch. Your doctor can give you a painkilling medication if necessary. Since the suture must not get wet from the outside (risk of infection), you may only shower using a special shower plaster. Should the wound nevertheless become wet, it is recommended that you carefully dab it dry with sterile compresses.
