Do you know what a laparotomy is?
Do you know the applications of laparotomy in medicine? Are you looking for information about exploratory laparotomy and want to know the applications of exploratory laparotomy?
In the following we will talk more about exploratory laparotomy:
First of all, it is better to say what laparotomy means in medicine. Doctors define laparotomy as making a large incision in the abdominal wall and entering the cavity and space of the abdomen.
Now, for what purpose or purposes is a laparotomy performed?
The surgeon may aim to cut the abdominal wall and enter the abdomen only to search for exploitation.
That is, it wants to investigate something, or to investigate an accident and the occurrence and existence or non-existence of harm, or to determine something. Diagnostic exploratory laparotomies are performed in cases where the physician has not been able or is not able to make a good and accurate diagnosis by other methods.
Therefore, the surgeon’s goal in cutting the abdominal wall and entering the abdomen may be diagnostic (it has entered the abdomen for diagnostic reasons.)
Or the purpose of cutting the abdominal wall and entering the abdominal cavity may have been for medical purposes.
In the following, we will see for what purposes a laparotomy is performed:
When do a doctor and surgeon go for a laparotomy?
Inflammation of the appendix or appendicitis that will be therapeutic laparotomy
Pancreatitis or inflammation of the pancreas which will be a diagnostic and therapeutic laparotomy.
Therapeutic intestinal obstructions laparotomy
Intestinal rupture, diagnostic and therapeutic laparotomy
Diagnostic and ectopic pregnancies
Adhesions after diagnostic and therapeutic laparotomy abdominal surgeries
Examination of the abdomen and intra-abdominal organs when a bullet hits the abdomen, which will be an exploratory laparotomy, during which the doctor will look for existing injuries.
Laparotomy, which is equivalent to make an incision in the abdomen and entering the abdominal cavity, provides the surgeon with access to the following organs:
- Small intestine (duodenum, jejunum, and ilium are the three structural parts of the small intestine, respectively)
- Uterus and fallopian tubes and ovaries
- Lymph nodes of the abdomen
- Abdominal vessels
- Abdominal aorta
- The spleen
But learn more about exploratory laparotomy
What is exploratory laparotomy?
In this case, the surgeon did not cut the abdomen and enter the abdomen with the aim of treating or removing the limb, but performed a laparotomy with the aim of finding the possible cause of the problem. For example, the patient has gastrointestinal bleeding or abdominal pain that has not been diagnosed by other methods. And now the surgeon, by opening the abdomen, wants to directly examine what is the cause of the patient’s clinical problem.
Exploratory laparotomy will also be used in cases where there is a serious injury to the abdomen that requires immediate and urgent care (such as a bullet entering the abdomen).
Exploratory laparotomy is performed by General Surgeon and the surgeon opens the abdomen with a large incision or long cut and examines and explores the internal organs for possible injuries and diseases.
It is common for injured people who have been stabbed in the abdomen to be taken to hospital. Surgeons call these injuries penetrating abdominal traumas, which can be potentially life-threatening. Emergency exploratory laparotomies will be very important in these injuries. Exploratory laparotomies are major surgeries that must be performed in a well-equipped hospital, and lung and heart health will be required for general anesthesia.
When is an exploratory laparotomy necessary?
In the following cases, exploratory laparotomy is necessary:
- Abdominal problems and discomfort have been around for a long time, but their cause has not been detected by routine diagnostic tests.
- When a patient is transported to a hospital with a major abdominal trauma and the trauma is so severe that the risk of serious, life-threatening injury is very high and there will be no time for tests, imaging, and diagnostic procedures.
The following steps can be performed during exploratory laparotomies:
- Sampling of suspicious tissues
- Determination of tumor stage
- If necessary, perform surgical or restorative procedures
In ancient times, when advances in imaging technologies were not as great as they are today, exploratory laparotomy was widely used.
Of course, this method is still used today in centers that do not have access to radiology modalities, and another point is that in many cases, exploratory laparotomy has been substituted for diagnostic laparotomy. Exploratory laparoscopy does not require general anesthesia and does not involve a large incision in the abdominal wall.
But the point is that in some centers, there is no laparoscopic equipment and a professional surgeon who has been trained to use a laparoscope, and sometimes, despite the exploratory laparoscopy, the unknowns still remain. In these cases, exploratory laparotomy will help the diagnosis and treatment team.
Laparoscopy is not possible in the following cases:
- A person who has multiple scars on the abdominal wall
- Abdominal dilation
- Infection in the abdominal wall
- Life-threatening emergencies
- History of laparotomy in the last thirty days
What will happen before, during and after the exploratory laparotomy?
We said that exploratory laparotomy is a major surgery, so the person in the hospital and after examining the heart and lungs receives general anesthesia.
Through it, the surgeon has access to the abdominal cavity. The organs are carefully examined and suspicious tissues are biopsied. The tissue damage, for example, due to the entry of a bullet or a knife, is examined. And the necessary action is taken, at the end of the procedure, the incision is sutured and the abdominal wall is closed.
A drain is often inserted into the abdominal cavity to remove excess secretions and fluid. After the exploratory laparotomy and after the initial recovery, the patient will stay in the hospital for a few days. During this time, the treatment team is careful to create possible clots in the legs. As the discharge decreases, the drain is removed in the days following surgery.
During this period, the person’s condition stabilizes and oral nutrition, if tolerated, begins. With relative improvement, the patient can walk slowly and will be discharged by taking instructions related to wound care and awareness of warning signs.
It takes about six weeks to repair and recover from a stomach injury, which varies from person to person
Exploratory laparotomy complications
- Side effects of anesthetics and abnormal reactions to general anesthesia
- Injury to the intestines and intra-abdominal organs during laparotomy
- Failure to repair the incision
- The protrusion of the viscera inside the abdomen from the incision site is called incisional hernia
When should we see a doctor?
We emphasize that if you have had an exploratory laparotomy, you should inform your doctor immediately if you encounter one or more of the following:
- Fever above thirty-eight degrees Celsius or above one hundred degrees Fahrenheit
- Increasing pain
- Swelling and redness of the incision
- Bleeding or discharge of yellow and green discharge from the surgical incision site
- Chest pain
- Diarrhea for more than two days
- Prolonged constipation for more than two days
- Swelling of the abdomen
- Shortness of breath
- Increase the number of breaths
- Leg pain and swelling are usually unilateral
- Persistent coughs
- Dark stools
- The presence of blood in the stool
- Blood in vomit
- Painful urination