Laparotomy is a procedure that involves opening the abdominal wall. Laparotomy can be exploratory (diagnostic) or curative. But in what situations is laparotomy performed at all? Are there any contraindications for laparotomy and what are the complications after this procedure?

Laparotomywas first performed in 1809 by an American physician - Ephraim McDowell. The procedure was successful, even though… the patient who underwent him was not anesthetized before him. Currently, laparotomy is of course performed under anesthesia, but the general principle of the procedure has remained the same.

During laparotomy, surgeons gain access to the inside of the abdominal cavity. Currently, this procedure is often replaced by another procedure, which is less invasive - we are talking about laparoscopic procedures - however, sometimes it is most beneficial to perform a laparotomy.

Exploratory laparotomy and therapeutic laparotomy

There are generally two types of laparotomy, they are exploratory laparotomy (also called diagnostic laparotomy) and therapeutic laparotomy.

Exploratory (diagnostic) laparotomyis performed when it is necessary to diagnose symptoms existing in a patient, and at the same time it is not possible to identify their causes by other diagnostic methods.

An example can be used to explain when an exploratory laparotomy may be necessary. Well, it happens, for example, where the patient experiences extremely severe abdominal pain. It is possible that, despite the fact that even many studies have been carried out - incl. laboratory or imaging - the cause of the patient's problems cannot be detected, and he still experiences bothersome symptoms that hinder his functioning.

When other diagnostic methods fail, diagnostic laparotomy can help to find the causes of a patient's ailments - however, as it is an invasive procedure, it is rather used only when it is really necessary.

Therapeutic laparotomyis the second type of laparotomy and it is usually performed when the patient's disease is known (it may be, for example, a cancer of one of the abdominal organs).

In suchIn the case of an abdominal laparotomy, it is usually only one of several steps in the entire procedure. Once the doctor has obtained the desired tissue access, he can take the next steps during the operation - such as removal of the neoplastic lesion, uterine resection or appendectomy (removal of the appendix).

Laparotomy: what is the procedure?

Laparotomy is a highly invasive surgical procedure. During the procedure, the skin, subcutaneous tissue, muscles and peritoneum are cut. Basically, this is what the laparotomy itself is about - the procedure is to expose the abdominal cavity to surgeons.

Subsequent interventions by doctors depend on the indications for laparotomy.
It is difficult to clearly define how long a laparotomy lasts.

This procedure may take several dozen minutes (especially in the case of exploratory laparotomy) and even several hours (this may happen in the case of therapeutic laparotomy, which is one of the stages of, for example, extensive surgery of an advanced bowel cancer). Finally, the procedure ends with the treatment of the resulting wounds, i.e. with the suturing of the tissues cut at the beginning of the operation.

Laparotomy: types of cuts

There are several different types of cuts that are used in laparotomy. They are mainly:

  • midline incisions (the upper, extending from the xiphoid end of the sternum to the umbilicus, and the lower, extending from the navel to the pubic symphysis; an even longer median incision is also possible - from the xiphoid process to the pubic symphysis) but used very rarely)
  • Kocher cut (transverse cut that is performed under the costal arches)
  • Pfannenstein incision (transverse cut under the bundle and above the symphysis pubis, useful in gynecological laparotomy)

Laparotomy: preparation for the procedure

Laparotomy is sometimes performed in an emergency (e.g. in patients who are victims of a car accident) - in this case it is quite obvious that the operation is performed without any special preparations.

The situation is different, however, when the procedure is performed electively - in this case, patients must be properly prepared before the laparotomy.

Preparations for laparotomy typically begin 24-48 hours before the surgery itself - usually then patients are admitted to the hospital.

The exact course of preparations depends on what exactlyinterventions are to be performed on the operated patient - for example, when the laparotomy is to be performed in order to interfere with the intestines, the patient may be required to use preparations cleansing the gastrointestinal tract.

When describing the preparation for laparotomy, it is impossible not to mention the skin - the place where the cut is to be made must be shaved off the hair before the procedure. It is also important to mention an aspect that interests many patients who are to undergo surgery - how is food and drink before laparotomy?

Well, this procedure is performed under general anesthesia and therefore for some time before it - usually 6 hours - it is necessary to refrain from consuming food and fluids. This time may also be longer, the final decision as to how long before laparotomy should be fasting is made by the doctor.

Laparotomy: indications

Laparotomy is used primarily in various diseases of the gastrointestinal tract. As mentioned earlier, the procedure can be performed for both diagnostic and therapeutic purposes - laparotomy can be used in the case of, among others, such diseases as:

  • cancers of the gastrointestinal tract (e.g. colorectal cancer, pancreatic cancer)
  • gastrointestinal perforation (e.g. gastric ulcer perforation)
  • complicated pancreatitis
  • appendicitis

Laparotomy is performed not only by surgeons, but also by gynecologists - procedures performed by specialists in the latter field are sometimes referred to as gynecological laparotomies.

In this case, the procedure can be used to treat various uterine diseases - laparotomy can be used, for example, to remove uterine fibroids. Another example of the application of the procedure in gynecology is the removal of changes that have developed within the ovary - laparotomy can be used, for example, to gain access to neoplastic changes of the ovary.

Another example of a problem treated with the procedure is endometriosis - laparotomy in this case may be used to remove endometriosis foci.

Laparotomy: contraindications

As in the case of other surgical procedures, also in the case of laparotomy there are various contraindications to its performance. The main aspect that prevents this operation from being performed is the patient's lack of consent - obtaining such consent is required before any operation.

Other contraindications for laparotomy include:

  • cardiopulmonary failure
  • significant blood clotting disorders, posing a risk of unmanageable bleeding during laparotomy,
  • severe obesity
  • advanced age (in this case it may rather be a contraindication to general anesthesia used during laparotomy)

Laparotomy: complications

Each surgical intervention - even the smallest one - is associated with a certain risk of various complications. Some of them are relatively trivial, others more serious, additionally they can appear with different frequency.

After laparotomy - due to the fact that it is a highly invasive procedure - many different complications may occur (it is precisely because of this risk that, whenever possible, instead of laparotomy, patients are treated with the method laparoscopic - they have a lower risk of complications).

The most common complication of laparotomy is infections. Other possible complications after this procedure include bleeding, the development of hematomas in the operated areas and postoperative hernias. It is also possible that during the procedure, the structures of e.g. the gastrointestinal tract or the urinary system will be damaged, but these are the rarest complications of laparotomy.

Laparotomy: convalescence

The fact that laparotomy is a highly invasive procedure is associated not only with the risk of complications, but also with the course and duration of recovery after laparotomy. For some time - usually two to three days - the patient who underwent the surgery remains in the hospital.

However, this time may be much longer - the specific hospitalization time after laparotomy depends on the exact surgical interventions that were performed on the patient.

When the patient leaves the hospital, he must remember that his convalescence is not finished yet. For a few weeks after the laparotomy, the patient has to spare himself - physical exertion related to housework (especially lifting) or playing sports are contraindicated during this period.

Yes, patients - whenever they are ready for it, and it usually happens within a dozen or so - several dozen hours after the surgery - are advised to walk, although the effort they make throughout the recovery period cannot be intense.

Among the possible complications of laparotomy, the risk of postoperative hernia was mentioned. The possibility of its appearance results from the fact that after laparotomy - in the place where the incision was made - the strength of the wall weakens.abdominal cavity.

There are certain factors that - apart from the fact of having an abdominal surgery - increase the risk of a postoperative hernia. This is mainly about smoking, obesity, wound infection and steroid therapy or chronic respiratory diseases.

As the last two may be difficult to avoid, it is possible to stop smoking, try to reduce excess body weight or take proper care of the postoperative wound - they are recommended for patients after laparotomy because they reduce the risk of developing postoperative hernia.

About the authorBow. Tomasz NęckiA graduate of medicine at the Medical University of Poznań. An admirer of the Polish sea (most willingly strolling along its shores with headphones in his ears), cats and books. In working with patients, he focuses on always listening to them and spending as much time as they need.

Category:

Gastrology