Laparotomy: Everything you need to know
Laparotomy is a type of open surgery of the abdomen to examine the abdominal organs.
Surgeons may use this surgery to diagnose and treat a variety of abdominal conditions.
Here, we look at the types and uses of laparotomy, as well as what people can expect during and after laparotomy surgery.
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 diagnose or treat abdominal health conditions.
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.
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.
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 the operation, people will be under general anesthetic. A surgeon will make one incision to cut through the abdominal skin and muscle to reveal the organs in the abdomen.
They will then examine the organs to diagnose any issues. If they can make a diagnosis, surgeons may be able to treat the condition straight away.
For conditions that surgeons cannot immediately treat, people may require repeat surgery.
After the diagnosis and the completion of any possible treatment, the surgeon will sew up, or suture, the incision.
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.
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
- 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.