Laparotomy is the surgical opening of the abdominal cavity. It takes place during a surgical procedure.
What is laparotomy?
Laparotomy is the medical term used to describe the opening of the human abdominal cavity during a surgical procedure. Laparatomy is the medical term for opening the human abdominal cavity during a surgical procedure. Laparatomy can be used for both diagnostic and therapeutic purposes. Performing a laparotomy gives the physician an opportunity to gain access to injured or diseased organs located in the abdominal cavity. In case of unclear complaints, laparotomy helps to gain insight into their cause. Such a procedure is called exploratory laparotomy. Other forms of this procedure include paramedian laparotomy, in which an incision is made longitudinally along the side of the midline, median laparotomy, in which an incision is made along the middle of the abdomen, and transverse laparotomy, in which the incision is made in the upper or middle abdomen transversely from the left to the right. There is also the subcostal laparotomy (rib-arch margin incision) at the lower rib, the flank incision, which is made in a lateral position from the anterior to the posterior direction, the acetabular pedicle incision horizontally across the midline, and the alternate incision, which is made diagonally in the right lower abdominal region. The type of incision is ultimately determined by the surgeon in order to obtain the best possible access to the surgical area. The surgical tolerance of the patient also plays an important role. Although in this day and age most abdominal incisions are made with minimally invasive procedures, there are still valid reasons for performing a laparotomy.
Function, effect, and goals
Unlike minimally invasive laparoscopy, which uses an endoscope, laparotomy involves an extensive abdominal incision. This may be necessary for a variety of indications. These include delivery by cesarean section, inflammatory abdominal diseases, cancers in abdominal organs, and transplants performed on abdominal organs such as the pancreas, kidneys, or liver. In addition, there are medical emergencies that require a laparotomy. These can be, for example, tears of the abdominal organs, intestinal obstruction, bulges on the blood vessels or bleeding. Exploratory laparotomy is a diagnostic procedure that takes place when there are unexplained complaints in the abdominal cavity. By looking at the abdominal organs, the surgeon tries to determine the cause of the condition. If the possibility exists, the trigger is corrected during the laparotomy. Usually, an exploratory laparotomy is performed when the patient suffers from severe pain in the abdomen that occurs within a few hours. Furthermore, tumor diseases can be well assessed by exploratory laparotomy. Before laparotomy is performed, the patient is administered general anesthesia. In most cases, the patient is placed on his back. Only rarely does he assume a lateral position. The next step is thorough disinfection of the surgical area. During this process, the patient is also covered with germ-free film sheets to prevent infection. With the help of a special pin, the surgeon marks the incision he has decided on in advance. In most cases, a median laparotomy is performed. This central incision is made from the upper to the lower direction and offers the advantage that the abdominal organs can be easily reached. Therefore, the median laparotomy is also suitable for complaints that are still unclear. In the middle of the abdomen, there is also mostly connective tissue instead of muscle. Bleeding is only light there. Sometimes, however, other incisions may be necessary. These include, for example, the costal margin incision, in which the opening of the abdomen is made under the left or right costal arch. The right costal margin incision is particularly suitable for operations on the bile ducts, gallbladder and liver, while the left incision is used for operations on the pancreas and spleen. If the appendix is removed, the alternate incision is used.In the process, the surgeon makes a 3 to 5 centimeter long incision in the right lower abdomen that goes all the way to the muscle membranes. The transverse muscle and the inner muscle are then pressed apart with the fingers. In this way, the surgeon gains access to the surgical area. The acetabular pedicle incision is used for gynecologic procedures, while the flank incision provides access to the small intestine, pancreas, and kidneys.
Risks, side effects, and hazards
Laparotomy is not free of risks and side effects. Most notably, there is a risk of bleeding, which can sometimes even require a blood transfusion. In addition, if there is extensive postoperative bleeding, another operation may be necessary. Other possible side effects of laparotomy include inflammation, infection, nerve injury, accumulation of wound fluid and the development of hematomas (bruises). Furthermore, wound healing disorders, hernias (scar hernias), and excessive scars that are cosmetically noticeable can occur. In certain procedures, there is also the possibility that an abdominal organ may be injured. Wound pain usually occurs after laparotomy because a larger wound is created in the process. The discomfort is primarily noticeable when the abdominal wall is strained, such as laughing, sneezing, coughing, stretching or when standing up. In the suture area, the wound is also very sensitive to touch. To counteract infection, external wetness on the suture must be prevented. Showering, for example, should only be done with a special wound plaster. After about two weeks, the staples or sutures of the suture are removed by the doctor.
