Laparotomy

What is it?
Laparotomy, also called Coeliotomy, is a surgical procedure that is performed in the abdominal region using the traditional or full-size incision or cut compared to Laparoscopy, which uses tiny incision or cuts.

Laparotomy is typically used to investigate the problem causing severe abdominal pain in patients. In several cases, it might also be used to treat abdominal pain issues.

In Laparotomy, the surgeon will create an incision causing an opening through which the surgical team can view the organs, blood vessels, and tissues in the abdominal cavity. It might also use laparoscopic instruments that can be inserted through tiny incisions to see the internal structures and also to treat/repair using the tiny surgical instruments.

When is it needed?
The decision to use Laparotomy is usually taken by the surgeon in cases of emergency, an unstable patient or the case where a large incision is required. Some of these cases are:

• A perforation in the intestine
• Trauma, cirrhosis, liver enlargement, need for stenting
• Blockage such as kidney stones
• Endometriosis, cancer, ectopic pregnancy, inflammation
• Repairing hernias within the abdominal wall.
• Removing the diseased tissue and diseased organs.
• Repairing various abnormalities within the abdomen.

Procedure
A Laparotomy procedure is typically performed under general anesthesia. The surgeon makes an incision on the abdomen and dissects the abdomen in layers until the organs are seen. The abdominal cavity and the internal organs are then examined for any disease. Tissue samples will be taken for examination.

The surgeon might perform a pelvic washing, which involves irrigating the abdominal cavity with sterile fluid and collecting this fluid, to look for abnormal cells. After the completion of the procedure, the abdomen is then closed in layers and the skin incision is sutured.

Some people may need a stoma, a temporary arrangement to allow the bowel time to heal, after an emergency laparotomy. A stoma is typically done when one of the ends of the bowel is brought out through a hole in the abdomen and stitched to the surface of the abdomen. This arrangement transfers the faeces from the bowel directly into a disposable bag. The healing can take three to six months, after which time the patient will have to undergo another operation to rejoin the bowel and have the stoma removed.

Post Procedure

• Take deep breaths and cough effectively. This helps to prevent chest infections.
• It usually takes many days for the bowels to work normally after an emergency laparotomy. During this time, the patient might feel bloated and have very little appetite. If the patient is still unable to start eating after two to three days, the surgeon might recommend liquid nutrition through a nasogastric tube or through a cannula into a vein.
• Getting the patient back to normal reduces the risk of complications such as deep vein thrombosis and chest infections.

Complications

• Hemorrhage
• Infection
• Damage to internal organs
• Formation of internal scar tissue
• Bowel blockages or abdominal pain caused by adhesions