What is Exploratory Laparotomy?
An exploratory laparotomy is an open surgical procedure for visual examination of the abdominal organs, tissue and blood vessels. An exploratory laparotomy is often an emergency procedure for patients with acute abdominal pain from disease or injury to the abdomen.
Before Exploratory Laparotomy
Why it’s done
When and why is an exploratory lap performed?
Exploratory laparotomy can be used when you:
. Have serious or long-term abdominal symptoms that defy diagnosis.
. Have had major abdominal trauma and there’s no time for other testing.
. Are not a good candidate for laparoscopic surgery.
This surgery can be used to explore:
. Abdominal blood vessels
. Large intestine (colon)
. Pancreas
. Appendix
. Liver
. Small intestine
. Fallopian tubes
. Lymph nodes
. Spleen
. Gallbladder
. Membranes in the abdominal cavity
. Stomach
. Kidneys
. Ovaries
. Uterus
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In addition to visual inspection, the surgeon can:
. Take a sample of tissue to test for cancer (biopsy).
. Make any necessary surgical repairs.
. Stage cancer.
The need for exploratory laparotomy is not as great as it used to be. This is due to advances in imaging technology. Also, when possible, laparoscopy is a less invasive way to explore the abdomen.
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Risks and Complications
What are the risks and complications of an exploratory laparotomy?
An exploratory laparotomy is a major surgical procedure potentially involving several vital organs. The risks are higher for malignant diseases and serious trauma. Risks and complications include:
Anesthetic side effects such as:
. Headache
. Nausea
. Confusion
Surgical risks such as:
. Infection
. Pneumonia
. Bleeding
. Blood clots
. Organ damage
. Collapse of the lung (pulmonary atelectasis)
. Reaction to medications
. Wound infection and sepsis
. Paralysis of intestinal muscles (paralytic ileus)
. Opening of stomach wall sutures (abdominal wall dehiscence)
. Abscess or collection of pus or fluid in the abdomen
. Abnormal connection between the intestine or stomach and the skin (enterocutaneous fistula)
. Adhesions in the intestines causing obstruction
. Incisional hernia
. Death
Wound infections are the most common complication after an exploratory laparotomy, especially if there is gastric content leakage. Death rate is high in laparotomy performed in cases of trauma because of hemorrhage.
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How to Prepare
Prior to your surgery, you will meet with your surgeon and a nurse from the anesthesia team. During these appointments, be sure to inform them of any allergies you have and all the medications you are taking.
These types of medications include the following:
. Prescription medications
. Over-the-counter medications
. Vitamins, herbals, or supplements
. Recreational drugs
Once your surgery is scheduled, your surgeon will provide you with instructions on how to prepare for the operation.
These instructions may include the following:
. Arrival time for your surgery and what to wear and bring with you
. Which medications to continue and/or stop prior to surgery
. Lifestyle habits to adopt prior to surgery (e.g., stop smoking and drinking alcohol)
. When to stop drinking and eating before your surgery
It’s important to keep in mind that for emergent exploratory laparotomies, the preparation protocol is different because the patient has a potentially life-threatening condition. In these time-sensitive situations, the healthcare team must balance carrying out therapies that will optimize the patient’s outcome, while not delaying surgery unnecessarily.
Some of these preparatory strategies may include administering:
. Antibiotics
. Fluid and electrolytes
. Blood products
During Exploratory Laparotomy
What to expect during the procedure
Exploratory laparotomy is major surgery. In the hospital, your heart and lungs will be checked to make sure it’s safe to use general anesthesia. An intravenous (IV) line will be inserted into your arm or hand. Your vital signs will be monitored. You may also need a breathing tube or a catheter.
During the procedure, you’ll be asleep, so you won’t feel anything.
Once your skin is disinfected, a long vertical incision will be made on your abdomen. The surgeon will then inspect your abdomen for damage or disease. If there’s suspicious tissue, a sample can be taken for biopsy. If the cause of the problem can be determined, it can be surgically treated at this time, too.
The incision will be closed with stitches or staples. You may be left with a temporary drain to let excess fluids flow out.
You’ll probably spend several days in the hospital.
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After Exploratory Laparotomy
Recovery
While the recovery time for an exploratory laparotomy varies based on the extent of the surgery, you can expect to stay in the hospital for approximately five to 10 days. Full recovery from an exploratory laparotomy may take four to six weeks.
Emergent exploratory laparotomies performed as a result of trauma (for example, a patient who was in a car accident with internal bleeding) may require a longer healing period.
Likewise, a patient with cancer may have a more complicated recovery, as the treatment for their cancer may overlap with recovery. The same is true when having an additional surgical procedure with the laparotomy.
Once discharged from the hospital, in order to maximize healing after surgery and to minimize the possibility of complications, it’s important to carefully follow your surgeon’s instructions for post-operative care.
Some of these instructions may include the following:
. To control pain, take Tylenol (acetaminophen) or, if more significant, your prescribed opioid as directed.
. To prevent infection, wash your hands before and after touching your incision site(s).
. When showering, let the water run over the incision site and pat the site dry; avoid soaking in a bath or hot tub.
. Take anti-nausea and anti-constipation medications as advised.
Contact your doctor if you experience these symptoms
Once you’re home, contact your doctor if you have:
. Fever of 100.4°F (38.0°C) or higher
. Increasing pain that doesn’t respond to medication
. Redness, swelling, bleeding, or yellow drainage at the incision site
. Abdominal swelling
. Bloody or black, tarry stools
. Diarrhea or constipation lasting more than two days
. Pain with urination
. Chest pain
. Shortness of breath
. Persistent cough
. Nausea, vomiting
. Dizziness, fainting
. Leg pain or swelling
These symptoms could indicate serious complications. Call your doctor right away if you experience any of them.
Long-Term Care
Once you are finished with the immediate recovery from an exploratory laparotomy, you may need further treatments, including additional surgeries, based on the surgeon’s findings. In order to move forward with any additional therapies, and to ensure you are healing well, you will likely have multiple follow-up appointments.
No doubt, the entire process from the start of surgery to recovering from it can be time-intensive, as well as physically and emotionally taxing. Try to lean on loved ones during this time.
Sources :
https://www.healthline.com/health/exploratory-laparotomy-why-its-done-what-to-expect
https://en.wikipedia.org/wiki/Exploratory_surgery
https://www.cancer.gov/publications/dictionaries/cancer-terms/def/exploratory-surgery