Laparotomy

A laparotomy is a major surgical procedure that allows doctors to open the abdomen and examine the organs inside. Whether used to diagnose mysterious symptoms or treat serious conditions, this operation plays a crucial role in modern medicine.

celiotomy, abdominal exploration, peritoneotomy

Table of contents

• What is a laparotomy
• Why you might need a laparotomy
• Organs that can be examined
• Types of incisions
• Before the surgery
• During the surgery
• After the surgery
• Recovery and care at home
• Possible complications
• Laparotomy versus laparoscopy

What is a laparotomy

A laparotomy is a surgical procedure in which a surgeon makes a large incision in the abdomen to gain access to the organs inside^[1]. The word comes from the Greek words “lapara,” meaning flank or the soft part of the body between the ribs and hip, and “tomy,” meaning cut^[3]. In medical practice, this translates to a big cut through the abdominal wall to reach the peritoneal cavity, which is the space that contains your abdominal and pelvic organs^[1].

Sometimes a laparotomy is exploratory, meaning it is performed when the nature of the disease is unknown and the surgeon needs to look inside to identify the problem^[5]. In these cases, doctors use imaging tests like X-rays or CT scans first, but when these cannot provide a clear answer, a laparotomy becomes necessary^[2]. The procedure can also be therapeutic, meaning the surgeon already knows what the problem is and performs the operation to treat it^[1].

This is considered a standard procedure that any hospital can provide^[1]. In the United Kingdom alone, approximately 30,000 to 50,000 laparotomies are performed each year^[3].

Why you might need a laparotomy

Your surgeon might recommend a laparotomy for several reasons. Most commonly, it is used to investigate unexplained abdominal pain or internal bleeding when imaging tests have not been able to identify the source of the problem^[1]. The surgeon might need access to multiple organs if they don’t know exactly where the issue is located or how widely it might be spread^[1].

A laparotomy may be performed as an emergency procedure or as a planned operation^[1]. Emergency situations include traumatic abdominal injuries, where the surgeon needs to quickly find and repair damage caused by an accident^[1]. Other urgent conditions that may require immediate laparotomy include infection in the peritoneal cavity (called peritonitis), a perforated organ such as the stomach or intestines, or uncontrolled bleeding in the digestive tract^[1].

Planned laparotomies are scheduled in advance for various medical needs. You might have one for a cesarean section to deliver a baby, or to remove an organ such as the uterus, spleen, or part of the pancreas^[1]. Surgeons also use laparotomy for cancer staging, which means finding out how far cancer has spread from its original location^[1]. In addition, the procedure allows doctors to take tissue samples for biopsy, which is when a small piece of tissue is removed and examined in a laboratory to help diagnose diseases^[1].

Other medical conditions that may require a laparotomy include complicated appendicitis requiring an emergency appendectomy, a ruptured spleen, ovarian cysts or endometrioma, endometriosis that needs to be staged and treated, and various types of cancer affecting abdominal organs^[1].

Organs that can be examined

• Stomach
• Intestines (both small and large intestine, including the colon)
• Appendix
• Liver
• Gallbladder
• Bile ducts
• Pancreas
• Spleen
• Kidneys
• Adrenal glands
• Ureters
• Bladder
• Female reproductive organs (uterus, fallopian tubes, and ovaries)

During a laparotomy, your surgeon has direct visual access to examine all of these organs carefully^[1]. This comprehensive view allows them to look for signs of disease, injury, infection, or abnormal growths that might not be visible on imaging scans.

Types of incisions

There are several different types of incisions that a surgeon can make during a laparotomy, and the choice depends on which organs need to be examined or treated^[4].

The most common type is a midline incision, which runs vertically down the center of the abdomen along a natural line called the linea alba^[5]. This fibrous plane runs from the breastbone down to the pubic bone and contains very few blood vessels, making it a favorable location for surgery^[3]. An upper midline incision usually extends from the bottom of the breastbone to the belly button, while a lower midline incision is limited by the belly button above and the pubic bone below^[5]. Sometimes a single long incision extending from the breastbone all the way to the pubic bone is used, especially in trauma surgery when the surgeon needs maximum access^[5].

A paramedian incision is a vertical cut made to one side of the midline and is often used to access the kidneys and adrenal glands^[4]. A transverse incision is a horizontal cut across the abdomen that may cause less damage to the nerves supplying the abdominal muscles and tends to heal well^[4].

For procedures involving the pelvic region, such as an emergency cesarean delivery, surgeons may use a Pfannenstiel incision^[4]. A subcostal incision is a diagonal cut across the upper abdomen, used to access the gallbladder or liver on the right side, or the spleen on the left side^[4]. When subcostal incisions are made on both sides and meet in the middle, this creates a rooftop or chevron incision^[4].

Before the surgery

Before your laparotomy, your doctor or surgeon will take several important steps to prepare you for the operation^[2]. They will ask about your complete medical and surgical history, including any medications you are currently taking and lifestyle factors such as smoking, which can affect how well you heal after surgery^[2].

Your surgeon will explain the operation in detail and discuss the possibility of additional surgery if a diagnosis is made during the procedure^[2]. You will receive information about what to expect before, during, and after the operation, and you will be asked to give your consent for the surgery^[2].

Several tests may be conducted beforehand, such as X-rays and blood tests, to make sure you are healthy enough for surgery^[2]. An anesthetist, who is a doctor specialized in giving anesthesia, will check that you are fit for the operation and note any allergies you may have^[2].

In the hours leading up to surgery, you will need to follow specific instructions. You will be asked not to eat or drink anything for several hours before the procedure^[2]. The abdominal area will be shaved to reduce the risk of infection^[2]. You may be given a special surgical scrub lotion to use in the shower and a hospital gown to wear^[2]. In some cases, you may be given an enema or other bowel preparation to help empty your bowels before surgery^[2].

During the surgery

A laparotomy is performed under general anesthesia, which means you will be completely asleep and will not feel any pain during the operation^[2]. The surgeon makes a single incision through the skin and muscle layers of your abdomen to reach the organs inside^[2].

When the surgeon cuts through the abdominal wall, they must pass through several layers of tissue. Starting from the outside, these include skin, fat beneath the skin, layers of connective tissue called fascia, various abdominal muscles, more fascia, and finally the peritoneum, which is the thin membrane that lines the abdominal cavity^[3].

Once the abdomen is open, the surgeon carefully examines the exposed organs, looking for any abnormalities^[2]. If they identify a problem that can be treated immediately, such as a perforated bowel that needs repair or an inflamed appendix that needs removal, they may proceed with treatment during the same operation^[2]. The surgeon may also remove small samples of tissue for biopsy, especially if cancer is suspected^[8].

When the examination and any necessary treatments are complete, the surgeon closes the incision using stitches or surgical staples^[2]. In some cases, a temporary drain may be placed near the incision to allow excess fluids to flow out as you heal^[4].

After the surgery

After your laparotomy is completed, you will be moved to a recovery room where medical staff will monitor you closely as you wake up from anesthesia^[2]. You will likely need to stay in the hospital for several days while doctors watch your progress and make sure there are no signs of infection, blood clots, or breathing problems^[2].

It is normal to feel weak and tired after the surgery^[16]. You may feel sick to your stomach, and it is common to have pain in your belly and around the incision site^[16]. Your healthcare team will provide pain medication to help manage your discomfort^[16].

You will have a dressing or skin adhesive covering your incision to help it heal and protect it from infection^[16]. Your doctor will give you specific instructions on how to care for the wound. If you have strips of tape on the incision, you should leave them in place until they fall off on their own^[16]. If you have staples or stitches that don’t dissolve by themselves, you will need to return to have them removed, usually within 10 to 14 days^[16].

In the first day or two after surgery, you may be encouraged to do simple breathing exercises to help prevent pneumonia^[16]. When you cough or take deep breaths, holding a pillow against your incision can support your belly and reduce pain^[16].

Recovery and care at home

Recovery from a laparotomy takes time, and each person heals at their own pace^[16]. The pain around your incision should gradually improve over the next few weeks^[16]. You may be able to return to your usual activities within two to four weeks, though some people need more time^[16]. Many people are able to return to work within a few weeks after surgery^[16].

Getting enough rest is important for healing, but you should also try to stay active^[16]. Walking is a good choice for gentle exercise^[16]. However, you should avoid moving quickly or lifting anything heavy until you feel better and your doctor gives you permission^[16]. You will need to ask your doctor when you can safely drive again and when it is okay to resume sexual activity^[16].

Unless your doctor advises otherwise, you can eat your normal diet^[16]. If your stomach is upset, start with small amounts of bland foods^[16]. Drinking plenty of fluids is important, unless your doctor tells you to limit them^[16].

Your bowel movements may not be regular for one to two weeks after surgery, which is completely normal^[16]. To avoid constipation and straining, drink plenty of water and eat foods high in fiber^[16]. Your doctor may suggest a fiber supplement, stool softener, or mild laxative if needed^[16].

Caring for your incision is an important part of recovery. You may shower 24 to 48 hours after surgery, but you should pat the incision dry and avoid swimming or taking a bath for the first two weeks, or until your doctor says it is safe^[16]. Gently wash the area daily with warm, soapy water, rinse it, and pat it dry^[16]. Do not use hydrogen peroxide or alcohol on the wound, as these can slow healing^[16]. Keep the area clean and dry at all times^[16].

Your doctor will provide instructions about medications. If you were prescribed antibiotics, take them exactly as directed and complete the full course even if you start feeling better^[16]. For pain relief, take any prescribed pain medication as directed, or ask your doctor if you can use over-the-counter options^[16].

Possible complications

Like any major surgery, a laparotomy carries some risks^[2]. Possible complications include infection at the surgical site or inside the abdominal cavity, bleeding, and damage to internal organs during the procedure^[6].

One complication that can develop over time is the formation of adhesions, which are bands of scar tissue that form inside the abdominal cavity^[2]. These adhesions can sometimes cause organs or parts of the intestines to stick together, potentially leading to bowel blockages later in life^[6].

Blood clots are another concern after major abdominal surgery^[2]. If a blood clot forms in a leg vein and then breaks loose and travels to the lungs or brain, it could cause serious problems such as a heart attack or stroke^[2]. This is why doctors carefully monitor patients after surgery and may encourage early movement to help prevent clots from forming.

Other potential side effects include abdominal pain and swelling^[6]. Your surgical team will watch for these complications during your hospital stay and will give you guidance on warning signs to watch for after you go home.

Laparotomy versus laparoscopy

Laparotomy and laparoscopy are two different methods for surgically exploring the inside of the abdomen^[1]. Understanding the differences can help you have informed conversations with your doctor about which approach might be best for your situation.

Laparoscopy, sometimes called “keyhole surgery,” is a less invasive alternative to open surgery^[2]. Instead of making one large incision, the surgeon makes several small incisions, each about 1 centimeter long^[2]. Through one of these small openings, they insert a laparoscope, which is a thin tube with a tiny camera and light on the end^[1]. The surgeon operates through the other small openings using specialized instruments, watching their work on a video screen^[1].

Each method has its own advantages and disadvantages. Laparoscopy is less invasive, creates smaller wounds, leaves smaller scars, and is generally easier to recover from^[1]. Patients who have laparoscopy typically experience less pain after surgery and can return to normal activities more quickly than those who have open surgery^[2].

However, laparoscopy requires special training and equipment, and the procedure takes longer to perform, which may not be practical in an emergency situation^[1]. A laparotomy, on the other hand, is a standard procedure that any hospital can provide^[1]. In certain urgent situations or when dealing with critical conditions, laparotomy may be more practical and faster, giving the surgeon complete and immediate access to all abdominal organs^[1].

Your surgeon will consider many factors when deciding which approach to use, including the urgency of your situation, the suspected location and extent of the problem, your overall health, and whether emergency access to multiple organs may be needed^[1].