Laparotomy

Definition

A laparotomy is a large incision made into the abdomen. Exploratory laparotomy is used to visualize and examine the structures inside of the abdominal cavity.A laparotomy is a surgical procedure involving an incision through the abdominal wall to gain access into the abdominal cavity. It is also known as coeliotomy.

Purpose

Exploratory laparotomy is a method of abdominal exploration, a diagnostic tool that allows physicians to examine the abdominal organs. The procedure may be recommended for a patient who has abdominal pain of unknown origin or who has sustained an injury to the abdomen. Injuries may occur as a result of blunt trauma (e.g., road traffic accident) or penetrating trauma (e.g., stab or gunshot wound). Because of the nature of the abdominal organs, there is a high risk of infection if organs rupture or are perforated. In addition, bleeding into the abdominal cavity is considered a medical emergency. Exploratory laparotomy is used to determine the source of pain or the extent of injury and perform repairs if needed.

Laparotomy may be performed to determine the cause of a patient’s symptoms or to establish the extent of a disease. For example, endometriosis is a disorder in which cells from the inner lining of the uterus grow elsewhere in the body, most commonly on the pelvic and abdominal organs. Endometrial growths, however, are difficult to visualize using standard imaging techniques such as x ray, ultrasound technology, or computed tomography (CT) scanning. Exploratory laparotomy may be used to examine the abdominal and pelvic organs (such as the ovaries, fallopian tubes, bladder, and rectum) for evidence of endometriosis. Any growths found may then be removed.

Some other conditions that may be discovered or investigated during exploratory laparotomy include:

• cancer of the abdominal organs
• peritonitis (inflammation of the peritoneum, the lining of the abdominal cavity)
• appendicitis (inflammation of the appendix)
• pancreatitis (inflammation of the pancreas)
• abscesses (a localized area of infection)
• adhesions (bands of scar tissue that form after trauma or surgery)
• diverticulitis (inflammation of sac-like structures in the walls of the intestines)
• intestinal perforation
• ectopic pregnancy (pregnancy occurring outside of the uterus)
• foreign bodies (e.g., a bullet in a gunshot victim)
• internal bleeding
Risks

Risks inherent to the use of general anesthesia include nausea, vomiting, sore throat, fatigue, headache, and muscle soreness; more rarely, blood pressure problems, allergic reaction, heart attack, or stroke may occur. Additional risks include bleeding, infection, injury to the abdominal organs or structures, or formation of adhesions (bands of scar tissue between organs).

Normal results

The results following exploratory laparotomy depend on the reasons why it was performed. The procedure may indicate that further treatment is necessary; for example, if cancer was detected, chemotherapy, radiation therapy, or more surgery may be recommended. In some cases, the abnormality is able to be treated during laparotomy, and no further treatment is necessary.