laparotomy

Under one laparotomy the surgical opening of an abdominal cavity is understood. It takes place during a surgical procedure.

What is the laparotomy?

In medicine, laparatomy refers to the opening of the human abdominal cavity during a surgical procedure.

In medicine, laparatomy refers to the opening of the human abdominal cavity during a surgical procedure. The laparatomy can be used for both diagnostic and therapeutic purposes.

Performing a laparotomy gives the doctor an opportunity to gain access to injured or diseased organs that are located in the abdominal cavity. In the case of unclear complaints, the laparotomy helps to identify the cause. Such a procedure is called exploratory laparotomy. Other forms of this procedure are the paramedian laparotomy, in which a longitudinal incision is made to the side of the midline, the median laparotomy, in which an incision is made along the middle of the abdomen, and the transverse laparotomy, in which the incision is made across the upper or middle abdominal area runs from the left to the right direction.

There is also the subcostal laparotomy (incision of the costal arch) on the lower rib, the flank incision, which runs from the anterior to the posterior direction in a lateral position, the acetabular pedicle incision horizontally across the midline and the alternating incision, which takes place 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 patient's operating tolerance also plays an important role. While most abdominal incisions are nowadays made with minimally invasive surgery, there are still valid reasons for performing a laparotomy.

Function, effect & goals

In contrast to minimally invasive laparoscopy, in which an endoscope is used, an extensive abdominal incision is made in laparotomy. This can be necessary for various indications. These include delivery by caesarean section, inflammatory abdominal cavity diseases, cancers in abdominal organs, and transplants that are performed on abdominal organs such as the pancreas, kidneys or liver.

In addition, there are medical emergencies that require a laparotomy. This can be, for example, tears in the abdominal organs, an intestinal obstruction, pouches in the blood vessels or bleeding.

A diagnostic procedure is the exploratory laparotomy, which takes place in the case of unexplained complaints in the abdominal cavity. By looking at the abdominal organs, the surgeon tries to determine the cause of the disease. If possible, the trigger is removed as part of the laparotomy. Usually, an exploratory laparotomy is done if the patient has severe abdominal pain that occurs within a few hours. In addition, tumor diseases can be assessed well through exploratory laparotomy.

Before a laparotomy is performed, the patient is given general anesthesia. In most cases, the patient is placed on their back. It rarely takes a lateral position. The next step is the thorough disinfection of the operating area. The patient is also covered with aseptic foil towels to prevent infection. With the help of a special pen, the surgeon marks the incision that he has decided in advance.

In most cases, a median laparotomy is performed. This central cut 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, instead of muscles, there is mostly connective tissue. The bleeding is only light there.

However, other cuts may sometimes be necessary. This includes, for example, the costal margin incision, in which the opening of the abdomen is made under the left or right costal arch.The right incision is particularly suitable for operations on the biliary tract, gall bladder and liver, while the left incision is used for operations on the pancreas and spleen.

The alternate incision is made when the appendix of the appendix is ​​removed. The surgeon makes a 3 to 5 centimeter long incision in the right lower abdomen, which goes down to the muscular membranes. The transverse and inner muscles are then pushed apart with the fingers. In this way, the surgeon gains access to the operating area.

The Pfannenstiel incision is used for gynecological interventions, while the flank incision provides access to the small intestine, the pancreas and the kidneys.

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Risks, side effects & dangers

Laparotomy is not free from risks and side effects. Above all, there is a risk of bleeding, which sometimes even makes a blood transfusion necessary. If there is extensive bleeding, a new operation may also be necessary.

Other possible side effects of the laparotomy are inflammation, infections, nerve injuries, the accumulation of wound fluid and the development of hematomas (bruises). Furthermore, wound healing disorders, hernias (incisional hernias) and excessive scars can occur that are cosmetically noticeable. With certain interventions there is also the possibility that an abdominal organ may be injured.

After the laparotomy, there is usually pain in the wound because it creates a larger wound. The symptoms are primarily noticeable when the abdominal wall is stressed such as laughing, sneezing, coughing, stretching or when standing up. The wound is also very sensitive to touch in the seam area. In order to counteract an infection, external moisture on the seam must be prevented. Showering is only allowed with a special adhesive plaster. After about two weeks, the doctor will remove the staples or sutures from the suture.