Exploratory laparotomy

Exploratory Laparotomy Dr Imran Javed.

Associate Professor Surgery. Fiji National University.

Indications

• Acute Abdomen due to: • 1-Trauma (Blunt & Penetrating). • 2- Infections (Acute & Chronic). • 3- Malignancy ( Treatment, Diagnosis & dealing with

Complications).

• 4- As a part of Gynecological or Urological Procedures.

• 5- Complicated Laparoscopic or Endoscopic Procedure.

• 6- Removal of Foreign Bodies like dislodged copper T.

Position.

• The patient is placed in the supine position, with the arms abducted at right angles to the body.

• The lithotomy position may be employed instead when a pelvic pathology is suspected and a simultaneous vaginal or rectal intervention is necessary.

Preop Prepration

• 4 Tube Principle:

• 1- Intravenous Line

• 2- Urinary Catheter.

• 3- Endotracheal tube.

• 4- CVP line in intensive monitoring.

• Preop Antibiotics.

• Arrangement of blood & Blood products.

Anesthesia.

• Exploratory laparotomy is performed with the patient under general anesthesia.

• Patients who are anesthetized for emergency surgery are at higher risk for aspiration of gastric contents. Adequate care must be taken to empty the stomach before induction.

Upper midline incision. Incision is deepened through subcutaneous tissue to

expose linea alba.

Linea alba is divided to reveal pre-peritoneal fat.

Abdominal incision is completed to reveal intra-abdominal organs.

Laparotomy in patient with peritonitis. Image shows perforated duodenal ulcer.

Laparotomy in patient with intestinal obstruction

Sigmoid volvulus with gangrene.

Multiple omental deposits in patient with disseminated carcinoma of stomach.

Multiple metastatic deposits over small bowel in patient with colonic malignancy

Liver laceration in traffic accident victim who presented with hemoperitoneum

Drains after an exploratory laparotomy

• Patients with extensive contamination may benefit from drains in the subhepatic space and the pelvis.

• Suction Drains may be needed for prevention of blood collections in the peritoneal cavity.

• Gravity Drains are placed for most of the routine procedures.

• Sump Drainage in cases of necrotizing Pancreatitis.

Single-layer mass closure

• Closure is carried out with either nonabsorbable suture material (eg, polypropylene) or a delayed absorbable suture material (eg, polydioxanone) in either a continuous suture or interrupted sutures. The standard approach is to place sutures about 1 cm from the edge of the incised linea alba, maintaining a distance of 1 cm between successive bites.

Complications of Procedure

• Immediate complications: • Paralytic ileus • Intra-abdominal collection or abscess • Wound infections • Abdominal wall dehiscence • Pulmonary atelectasis • Enterocutaneous fistula • Delayed complications : • Adhesive intestinal obstruction • Incisional hernia