Laparotomy

Laparotomy is an open surgery on the abdomen. It can help the surgeon both diagnose and treat certain problems. A diagnostic laparotomy makes it possible to localize the source of the problem in the abdominal cavity and correct it.

What is a laparotomy?

Laparotomy is a surgical procedure that involves cutting the abdominal cavity and visualizing internal organs

Sometimes a laparotomy is diagnostic - it is a way for your surgeon to see what is going on in the patient's body and possibly take tissue samples for additional tests (cytology, histology, culture). Laparotomy can have a curative effect when it comes to removing a foreign body, removing a problematic organ, stopping bleeding due to trauma.

Why is a laparotomy necessary?

Visual diagnostics does not always allow to localize the place of internal bleeding, pain, and the cause of septic exudate. In such cases, surgeons have to resort to laparotomy. Laparotomy allows access to all internal organs of the abdominal cavity. This is very convenient and relevant if the place of the main problem cannot be clearly localized

Laparotomy is often an emergency procedure, but not always. You may need a laparotomy for a planned or unplanned cesarean section. Your surgeon may order a laparotomy to remove an organ or tumor. Taking a biopsy

What organs are examined during a diagnostic laparotomy?

It may need to be checked:

• Stomach.
• Intestines.
• Spleen.
• Pancreas.
• Liver.
• Gallbladder.
• Bile ducts.
• Kidneys, adrenal glands and ureters.
• Bladder.
• Genital organs (ovaries, horns and body of the uterus, prostate)

What pathological conditions may require diagnostic laparotomy?

• Traumatic abdominal injury.
• Infection in the abdominal cavity (peritonitis).
• Perforation of the gastrointestinal tract or uncontrolled gastrointestinal bleeding.
• Emergency splenectomy for splenic rupture.
• Removal of a foreign body from the gastrointestinal tract
• Ovariohysterectomy for pathology of the ovaries and uterus
• Removal of tumors
• Removal of calculi from the bladder, ureters and kidneys

Is laparotomy a serious operation?

Yes. Whether it's a diagnostic laparotomy or a laparotomy for a limited purpose, such as organ removal, opening the abdomen is a major operation. The incision will be long and deep, and many layers of tissue will have to be restored. Recovery takes place in stages in a hospital or at home. The course of the operation also directly affects the patient's condition and recovery.

What happens before laparotomy?

Preparation before the operation includes:

• Informed consent. Your surgeon will describe the procedure, possible risks and alternatives, and the expected outcome.
• General clinical examination to assess the current condition. Collection of anamnesis. Conducting additional clinical studies such as: blood tests, ultrasound, ECHO, X-ray, CT, MRI. This is done to make sure that the operation and general anesthesia are safe for the patient.

What happens during a laparotomy?

Laparotomy involves a large incision of three to 30 cm in the abdominal cavity. The specifics of the incision and what happens afterwards will depend on the purpose of the operation. In general, the average duration of surgery is 1 hour. Patients are also fitted with various catheters and drains to administer medications during surgery and to drain physiological fluids. They may include:

• Intravenous catheter for administration of anesthesia, antibiotics and intravenous fluids.
• A nasogastric tube that is inserted through the nose into the stomach to drain fluid.
• Urinary catheter for bladder drainage.
• In some cases, surgical drainage may be required,
• feeding tube or parenteral nutrition (through an intravenous drip).

What types of laparotomy are there?

A laparotomy with a specific purpose, a diagnostic laparotomy, may have its own set of standardized steps. But often the course of the operation varies depending on the underlying pathology and the patient's condition. Thus, not every variant of the procedure is a standardized type.

There are also different types of laparotomy incisions that a surgeon can use. While the midline abdominal incision is the most common, giving access to all organs, the surgeon may use a different incision to focus on organs in a specific area.

Laparotomy incisions

The laparotomy incision passes through the skin, subcutaneous fatty tissue, fascia, and muscles. Examples of different laparotomy approaches:

• Medial. This is a standard laparotomy incision, also called a ventral laparotomy. It follows the vertical midline of the abdomen. If only the upper or lower half of the abdomen is needed, the incision can be above or below the navel.
• Paramedian. The paramedian incision also runs vertically through your abdomen, but on one side of the midline. This provides better access to the kidneys and ureters from a certain side.
• Paracostal. The paracostal incision (Kocher's incision) is diagonal on one side of the upper abdomen (epigastric region). Surgeons use it to access certain organs in these areas, such as the spleen or liver, gallbladder, and bile ducts on the right side.

What happens after the operation?

After the surgery is completed, the patient is transferred to the intensive care unit, where medical professionals monitor vital functions until the patient wakes up. Drains and catheters inserted into the patient's body during the surgery will remain in place to drain and deliver fluids. The patient must receive anesthetic therapy

After the end of the outpatient period, the doctor must instruct the owners of the animal on postoperative care of sutures, medication, and care of drains and catheters.

What are the benefits of laparotomy?

Laparotomy helps surgeons diagnose and treat a wide range of conditions, often simultaneously. All surgeons can perform a laparotomy, and they can adapt the procedure with different approaches to suit the situation. In general, surgeons use laparotomy only when it is necessary. It may be necessary for speed of diagnosis or because of the seriousness of your condition.

What are the risks of laparotomy?

Complications are possible:

• Unintentional damage to neighboring organs.
• Excessive bleeding from damaged blood vessels.
• Wound infection and slow healing.
• Areas of permanent numbness due to nerve damage.
• Hernias at the site of a muscle incision or split.
• Internal scar tissue that can interfere with organs (adhesions).

What is the recovery time after laparotomy?

It depends on the general condition and underlying pathology of the pet, as well as on how extensive the surgery was. The incision takes an average of 2-3 weeks to heal. A scar remains after healing

Laparotomy allows the surgeon to see and examine many organs simultaneously, which is important when the underlying pathology can affect any of them. It also allows urgent treatment of diseases after they are detected. It is not so easy to perform an open surgery, but when there are indications, you cannot delay. When the emergency is over, our medical team will help guide your pet through a long recovery process with minimal postoperative complications