Laparotomy

Is a laparotomy a major surgery?

What is Laparotomy?

Laparotomy is a surgical procedure that involves a surgeon making one large incision in the abdomen.

Doctors use laparotomy to look inside the abdominal cavity to examine the abdominal organs and aid diagnosis of any problems, including abdominal pain. In many cases, the problem – once identified – can be fixed during the laparotomy. In other cases, a second operation is required. Another name for laparotomy is abdominal exploration.

Before Laparotomy Surgery

Why is Laparotomy performed?

Doctors may use laparotomy for a variety of reasons. It can help them diagnose or treat abdominal conditions, such as:

. Abdominal pain

. Abdominal trauma

. Peritonitis, which is an inflammation of the inner lining of the abdomen

. A perforated organ in the abdomen

. Infection in the abdomen

. Internal bleeding

. The spread of conditions such as cancer or endometriosis

Females may have a laparotomy for a hysterectomy, which is the removal of the uterus, or for the removal of the ovaries or fallopian tubes.

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Complications

Some potential complications of laparotomy surgery are:

. Bad reaction to anesthesia

. Haemorrhage (bleeding)

. Infection

. Damage to internal organs

. Formation of internal scar tissue (adhesions)

. Bowel blockages or abdominal pain, which may be caused by adhesions.

Medical issues to consider

Before your operation, your doctor or surgeon will:

. Ask about your medical and surgical history and any lifestyle factors (such as current medications, or history of smoking) that may affect your operation.

. Explain the operation and discuss with you the possibility of further surgery once the diagnosis is made.

. Inform you about any procedures leading up to the operation (pre-operative) and what to expect following the operation. You will be asked to consent to the operation.

. Conduct tests like x-rays and blood tests.

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What to expect

Before the operation, a person can expect the following:

. A doctor will ask them not to eat for a certain number of hours before the operation.

. A doctor may give them an enema beforehand, which empties the bowels.

. The person may shower first with a surgical lotion, before putting on a theater gown.

. A healthcare professional will shave any hair in the abdominal area.

. An anesthetist will ensure that everything is ready for the operation and note any allergies that the person may have.

During Laparotomy Surgery

Types of laparotomy incisions

There are different types of incisions for laparotomy:

. Midline: This incision runs down the middle of the abdomen. It is the standard incision for laparotomy. If people only need surgery for their upper abdomen, the incision will not run the whole length of the abdomen.

. Paramedian: A paramedian incision is a vertical cut that runs to one side of the midline. It allows a surgeon to access the kidneys and adrenal glands.

. Transverse: A transverse incision is a horizontal cut. Surgeons may choose to use this approach because it can cause less damage to the nerves supplying the abdominal muscle, and it heals well.

. Pfannenstiel: Surgeons may use a Pfannenstiel incision to access the pelvic region, such as in the case of an emergency cesarean delivery.

. Subcostal: A subcostal incision is a diagonal cut across one side of the upper abdomen. A surgeon may use a subcostal incision to access the gallbladder or liver on the right side or the spleen on the left side.

. Rooftop (chevron): If the surgeon makes a subcostal incision on each side of the body, the incisions may meet in the middle to make a rooftop incision.

During Procedure

A laparotomy is performed under general anaesthesia. The surgeon makes a single cut through the skin and muscle of the abdomen, so that the underlying organs can be clearly viewed. The exposed organs are then carefully examined. Once diagnosed, the problem may be fixed on the spot (for example, a perforated bowel may be repaired). In other cases, a second operation may be needed. Once the laparotomy is complete, the muscle of the abdominal wall and the overlying skin are sutured (sewn) closed.

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After Laparotomy Surgery

Aftercare

Following the operation, the person will slowly wake up from the anesthetic. They will remain in the hospital for immediate aftercare.

This aftercare may include:

. Careful monitoring of temperature, pulse, breathing, and blood pressure

. Assessment of the wound site and wound care, possibly including drainage

. A tube through the nose into the stomach to drain the stomach for a day or two, if necessary, to help the digestive tract recover.

. The insertion of a urinary catheter to drain urine, if necessary

. Intravenous fluids, as people may have to avoid eating and drinking for a few days.

. Regular pain relief medication to ease discomfort.

. Deep breathing, leg exercises, and walking the day after the operation to help reduce the risk of chest infections and blood clots.

Some people feel nauseated after receiving an anesthetic. A doctor may be able to provide medication to relieve nausea.

Once the person is well enough to leave the hospital, a doctor will provide details of how to care for the abdominal wound at home.

The doctor will also provide any necessary medication and advice on how to rest and recover.

Recovery

As people can undergo a laparotomy for a wide range of reasons, the recovery time can vary significantly among individuals. Many other factors, including the person’s age and overall health, will also determine how long it takes them to feel better.

People can take steps at home to rest and allow their body to recover. These include:

. Resting as much as possible for days to weeks, depending on the doctor’s recommendation.

. Continuing to move around and do any exercises that a doctor has set.

. Getting other people to help around the home and with daily tasks, where possible.

. Following all dietary guidelines from a doctor

. Taking medication as a doctor prescribes

. Avoiding all heavy lifting, including pulling or pushing items, sexual activity, and swimming for 6 weeks.

It is usual to feel tired with low energy during recovery, as the body is healing. It is also quite common to experience a wide range of emotions and have difficulty sleeping.

People may be unable to drive during recovery, either because they are allowing their body to heal or due to the medications that they are taking. A person can check with their doctor and inform their insurance company if this is the case.

It is important to contact a doctor as soon as possible if any signs or symptoms of infection appear around the wound site. These may include:

. Increased pain or tenderness

. Redness

. Swelling

. Discharge from the wound site

. Fever or chills

. Vomiting or nausea

People should also seek medical help straight away if they have any symptoms of a blood clot, including:

. Difficulty breathing

. Chest pain

. Severe leg pain

People can carefully follow the doctor’s instructions and ensure that they have a final checkup at the end of their recovery period.

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Scarring

Laparotomy may cause a red, painful, raised scar across the abdomen, and it may take 6–8 weeks for this scarring to heal. In some cases, the scar will fade over time, but in others, it may be permanent.

Some people may develop abdominal adhesions after the surgery. Abdominal adhesions are bands of scar tissue inside the abdomen.

Abdominal adhesions are common, particularly following laparotomy.

Abdominal adhesions can sometimes lead to complications, such as causing a blockage in the intestines (small bowel obstruction). In females, abdominal adhesions can sometimes block areas of the reproductive system and cause infertility.

People should seek medical help straight away if they have any symptoms of abdominal adhesions, such as:

. Severe abdominal pain

. Bloating

. Constipation

. Not passing gas

. Nausea and vomiting

. Fever

Laparoscopy and celiotomy

Celiotomy is another term for laparotomy, and healthcare professionals may use these terms interchangeably.

An alternative to laparotomy is laparoscopy. Laparoscopy, or keyhole surgery, is when a surgeon makes one or more smaller incisions.

They will insert a small metal tube with a light and camera on one end — called a laparoscope — through one of these incisions to examine the area. They can also insert other surgical tools through the other incisions.

Laparoscopy has a shorter recovery time than laparotomy due to the smaller incisions. The decision to use laparotomy or laparoscopy will depend on the type of surgery, the surgeon’s experience with each technique, and the person’s overall health.

Laparotomy Surgery Cost

The cost of laparotomy surgery in Iran starts from $330.