laparotomy

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The opening of the abdominal cavity is called a laparotomy. This is done either as part of a surgical treatment or to find the cause of discomfort in the abdomen. Read all about the process of the laparotomy, when it is used and what the risks are.

What is a laparotomy?

A laparotomy is the medical term for an operative opening of the abdominal cavity. It gives the surgeon access to the abdominal organs during operations - for example, if an organ is sick or injured. Even in the case of unclear complaints in the abdominal region, an abdominal incision can help to find the cause. In this case, one speaks of an exploratory laparotomy. Depending on the type and direction in which the cut is made, a distinction is made between:

• median laparotomy (incision lengthways in the middle of the abdomen)
• Paramedian laparotomy (cut lengthways to the side of the midline
• Rib edge incision (subcostal laparotomy, incision along the course of the lower rib on the left or right
• transverse laparotomy (abdominal incision made transversely from left to right in the upper or middle abdomen)
• Alternating cut (shorter diagonal cut in the right lower abdomen)
• Pfannenstiel incision (transverse = cut horizontally across the center line in the lower abdomen
• Flank cut (cut across the flank from front to back in the side position)

Depending on the reason for the laparotomy, the surgeon selects the incision that gives him the best access to the surgical area and is at the same time most tolerable for the patient. Although nowadays many abdominal operations can be carried out "minimally invasive" - ​​that is, through small incisions for the surgical tool and the optical devices required for a laparoscopy - in many cases the operation on the surgically opened abdomen is still necessary.

When to do a laparotomy

The laparotomy is a common approach in major abdominal surgery. The abdominal incision is used, for example, in the following situations:

• Cancer of an abdominal organ
• inflammatory disease in the abdominal cavity
• Transplants of abdominal organs such as the liver, kidneys or pancreas
• Delivery by caesarean section.

Laparotomy is also the method of choice in emergency situations, such as bleeding, intestinal obstruction, torn abdominal organs or bulging of the abdominal vessels.

Exploratory laparotomy

An abdominal incision can be necessary not only for surgical interventions, but also for unclear abdominal complaints. Then one speaks of an exploratory laparotomy. Here the cause of the symptoms is to be found by a “look inside” and, if possible, eliminated in the same operation. Usually the abdominal incision is chosen for diagnostic purposes in the so-called acute abdomen; this is how severe abdominal pain that develops within hours is described in technical jargon. The doctor also uses the diagnostic laparotomy to assess the extent of the tumor.

What do you do with a laparotomy?

Below the costal arches the abdominal wall extends to the pubic bone. Seen from the outside, it consists of the skin, a layer of fat and the front, side and rear abdominal muscles. This is followed by the connective tissue covering the abdominal cavity and the peritoneum. The stomach, intestines, liver, gallbladder, pancreas, spleen, urinary bladder and the internal sexual organs in the pelvic ring are located in the abdominal cavity.

Before the operation

Before the start of the operation, the patient is given general anesthesia by the anesthetist. In abdominal surgery, he usually lies on his back, rarely on his side. The doctor now disinfects a large area of ​​the operating area and covers the patient with sterile foil towels in order to reduce the risk of infection. He then draws the chosen incision on the skin with a sterile pen. Now he can make the abdominal incision.

Median laparotomy

If the surgeon chooses the median laparotomy as the access route, he makes an oblong abdominal incision exactly in the middle of the abdomen. The navel is usually cut around on the left. If necessary, the surgeon can extend this incision up to the sternum and down to the pubic bone. This gives him optimal access to all organs in the abdomen. Almost all abdominal surgery can be performed using a median laparotomy.

Paramedian laparotomy

In the paramedian structural incision, as in the median laparotomy, a longitudinal incision is made. This runs about a cross finger next to the midline of the abdomen or along the outer edge of the straight abdominal muscle.

Costal edge incision

As the name suggests, the doctor here opens the abdominal cavity below the right or left costal arch. The right side of the costal arch is suitable for all operations on the liver, gallbladder and biliary tract. In this way the spleen and pancreas can be operated on on the left.

Transverse laparotomy

The transverse abdominal incision can be used in the upper, middle and lower abdomen. It can be attached on one side, but if necessary it can also be extended to the opposite side. Transverse abdominal incisions are primarily chosen for interventions where the objective of the operation is clear - not necessarily for exploratory laparotomy.

Alternate cut

The doctor makes an incision about three to five centimeters long in the right lower abdomen down to the muscular membranes. Then he uses his fingers to force the internal and transverse abdominal muscles apart in order to gain access to the abdominal organs. This incision is mainly used for operations on the appendix and appendix of the intestine.

Pan handle cut

The Pfannenstielschnitt describes an approximately eight to twelve centimeters long, transverse incision just above the pubic bone. Since the surgeon can see the female internal genital organs particularly well, the Pfannenstiel incision is a common technique in gynecological operations.

Flank cut

The flank incision is the classic access route for operations on organs that lie behind the peritoneum, such as the kidney, parts of the small intestine and the pancreas. The surgeon starts the incision on the lateral abdominal wall below the costal arch and guides it diagonally in the direction of the navel.

After the operation

Once the procedure is over, the abdominal wall must be carefully closed from the inside out. The muscle layer and the fatty tissue are sutured with threads that dissolve by themselves after a while, which could not be removed after the wound has healed. Then follows - usually in two layers, the closure of the subcutaneous fatty tissue and abdominal skin, either with staples or sutures. Both the staples and the sutures must be removed after about two weeks. Finally, the doctor bandages the patient's surgical wounds with sterile bandages.

After the anesthesia has ended, the anesthetist (anesthetist) takes the patient to the recovery room so that he can recover from the anesthesia under close observation.

What are the risks of a laparotomy?

As with any operation, a laparotomy can cause problems. The most common are:

• Bleeding and secondary bleeding, possibly with the need for a blood transfusion or - in the case of large secondary bleeding, a new operation.
• Bruising (hematoma) and accumulation of wound fluid (seroma)
• Injury to nerves
• Infection and inflammation
• Wound healing disorders
• Excessive or cosmetically noticeable scarring
• Incisional hernias

Other possible complications, such as injury to an organ, depend on the specific abdominal surgery.

What do I have to consider after a laparotomy?

Since a relatively large wound is created during a laparotomy, you must expect wound pain after the operation. You will feel this especially in the first few days after the procedure when you move that puts strain on the abdominal wall (standing up, stretching, coughing, sneezing, laughing).

In addition, the wound in the area of ​​the suture is initially sensitive to touch. Your doctor can give you pain reliever medication if necessary. Since the seam must not get wet from the outside (risk of infection), you may only shower using a special shower plaster. However, should the wound ever get wet, it is advisable to carefully pat it dry with sterile compresses.

The doctor removes the sutures or staples after about two weeks. How long you have to stay in the hospital after abdominal surgery with laparotomy depends on the particular operation. Until the wound has completely healed, avoid heavy lifting and sports that involve the abdominal wall.

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