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Laparotomy

Last updated Oct. 16, 2018

zarko kecman

Laparotomy is an exploratory surgical procedure performed on the abdomen that involves identifying, diagnosing, or treating, several different types of conditions.


Background Information:

What are the other Names for the Procedure?

  • Exploratory Laparotomy

What is Laparotomy surgical procedure?

Laparotomy is an exploratory surgical procedure performed on the abdomen that involves identifying, diagnosing, or treating, several different types of conditions.

What part of the Body does the Procedure involve?

Laparotomy involves the skin, abdominal muscles, surrounding abdominal organs, and peritoneum.

Why is the Laparotomy surgical procedure Performed?

A Laparotomy is performed for the following reasons:

  • For investigative reasons, such as examining the abdominal organs
  • Collecting tissue samples for further examination
  • Repairing hernias within the abdominal wall
  • Repairing or removing diseased tissue and diseased organs
  • Repairing various abnormalities within the abdomen

What are some Alternative Choices for the Procedure?

  • A minimally invasive surgical technique, termed laparoscopy, is an alternative to Laparotomy
  • Laparoscopy involves the visual examination of the internal body structures, using a camera

What are the Recent Advances in the Procedure?

A recent advance to laparotomy is keyhole surgery, which is also called as laparoscopy.

What is the Cost of performing the Laparotomy surgical procedure?

The cost of Laparotomy procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

  • It is normal for a patient to feel uncomfortable and confused with a sudden inflow of information regarding Laparotomy procedure and what needs to be done
  • If the patient needs further reassurance or a second opinion, a physician will almost always assist in recommending another physician
  • Also, if the procedure involves multiple surgeries or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently

What are some Helpful Resources?

http://www.surgery.com/procedure/laparotomy-exploratory (accessed on 08/03/2014)

Complete Guide to Symptoms, Illness & Surgery; Written by H Winter Griffith, M.D.; Revised and updated by Stephen Moore, M.D. and Kenneth Yoder, M.D.; The Berkley Publishing Group, 5th Edition, New York, 2006

Prior to Laparotomy surgical procedure:

How is the Laparotomy surgical procedure Performed?

  • A Laparotomy procedure is performed under general anesthesia
  • The surgeon makes an incision on the abdomen. The incision is usually vertical and in the midline, but the shape and location may vary depending on the aim of the procedure
  • The surgeon dissects the abdomen in layers, until the organs are seen
  • The surgeon then examines the abdominal cavity and the internal organs for any disease process. Tissue samples may be taken for examination
  • The surgeon may perform a pelvic washing - this involves irrigating the abdominal cavity with sterile fluid and collecting this fluid, to look for abnormal cells.  This is done sometimes to diagnose cancers
  • The surgeon may sometimes perform therapeutic procedures as well
  • After completion of procedure, the abdomen is closed in layers and the skin incision is sutured

Where is the Procedure Performed?

A Laparotomy procedure is performed in a hospital.

Who Performs the Procedure?

The Laparotomy procedure is performed by any of these medical personnel, with assistance from an anesthesiologist:

  • General surgeon
  • Obstetrician-gynecologist

How long will the Procedure take?

The Laparotomy procedure usually lasts for an hour or two.

What do you need to tell your Physician before the Procedure?

It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the Laparotomy procedure and helps avoid unnecessary complications.

  • Provide a complete list of medications you are currently, taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
  • If you are allergic to any specific medication or food items
  • If you are taking blood thinners, such as aspirin, warfarin, herbal supplements, or any other such medications
  • If you or your family members, have a history of bleeding disorders, or if there is a tendency to bleed more than normal
  • If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
  • If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
  • If you have a history of frequent bone fractures (this may affect bone-healing, if bones are involved as part of your procedure)
  • A list of all previous surgical procedures you have undergone, like for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.

What Preparations are needed, prior to the Procedure?

  • The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient including information related to the medications that are being currently taken
  • Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time, before the procedure is performed
  • Blood tests may be performed to determine if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure
  • Normally local anesthesia is not used; however do inform the physician if you are allergic to any local anesthetics, lidocaine, etc.
  • Avoid application of any cosmetics, deodorant, or topical medicines on the area, prior to the procedure
  • It is advisable to quit smoking and the use of any nicotine based products, for a while, before the surgery
  • Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
  • The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged
  • For persons suffering from diabetes, it is important that the blood sugar stays within the normal range; if not their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines

What is the Consent Process before the Procedure?

A physician will request your consent for Laparotomy procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What Tests are needed, before the Laparotomy surgical procedure?

Before a Laparotomy procedure, the patient has to undergo certain tests, such as:

  • Routine blood and urine analysis
  • X-rays of the kidneys, chest
  • Electrocardiography (ECG)
  • Ultrasound imaging
  • Magnetic resonance imaging (MRI) scan
  • Computerized tomography (CT) scan
  • Laparoscopy (occasionally)

What are some Questions for your Physician?

Some of the basic questions that you might ask your physician are as follows:

  • What is a Laparotomy?
  • Why is this procedure necessary? How will it help?
  • How soon should I get it done? Is it an emergency?
  • Who are the medical personnel involved in this procedure?
  • Where is the procedure performed? 
  • What are the risks while performing the procedure?
  • What are the complications that might take place, during recovery?
  • How long will it take to recover? When can I resume normal work?
  • How many such procedures have you (the physician) performed?
  • Are there any follow-up tests, periodic visits to the healthcare facility required, after the procedure?
  • What are the costs involved?

During the Laparotomy surgical procedure:

What kind of Anesthesia is given, during the Procedure?

Spinal anesthesia by injection or general anesthesia by injection and inhalation is administered, prior to the Laparotomy procedure.

How much Blood will you lose, during the Procedure?

Usually blood loss during a Laparotomy procedure is minimal, unless any complications occur.

What are the possible Risks and Complications during Laparotomy surgical procedure?

There are general factors that increase the risk of getting complications during surgery and they include:

  • Obesity: Generally greater the degree of obesity, greater is the surgical risk
  • Smoking: Longer the smoking history (in pack years smoked), greater the surgical risk
  • Advancing age
  • Poorly controlled diabetes, as evidenced by a high hemoglobin A1c and a high fasting glucose
  • Poorly functioning kidney, as evidenced by increased BUN (blood urea nitrogen) and blood creatinine
  • Poorly functioning liver, as evidenced by increased blood liver function tests
  • Hypertension (increased blood pressure), especially if it is poorly controlled
  • Poor nutritional status (malnutrition with mineral and vitamin deficiencies)
  • Poor lung function, as evidenced by abnormal lung function tests
  • History of bleeding disorders
  • Longstanding illness, such as autoimmune disorders, chronic infections
  • Poor immune system due to a variety of causes

The possible risks or complications that may arise during Laparotomy surgery are:

  • Excessive bleeding
  • Infection surrounding the surgical wound
  • Anesthetic complications
  • Accidental injury to the neighboring tissues

What Post-Operative Care is needed at the Healthcare Facility after Laparotomy surgical procedure?

  • After the surgical procedure, patients will be sent to an area of the hospital, called postoperative recovery area (or PACU)
  • The patient’s blood pressure, heart rate, and respiration cycle will be closely monitored. Any additional pain associated with the procedure will also be treated
  • Individuals are usually discharged from the hospital, 3-5 days after the surgery 

After the Laparotomy surgical procedure:

What are the possible Risks and Complications after Laparotomy surgical procedure?

The possible risks and complications that may arise after a Laparotomy procedure are:

  • Excessive bleeding
  • Excessive abnormal scarring
  • Abnormal abscess formation
  • Infection in the surgical wound
  • Obstruction of the urinary system or bowel
  • Incisional hernia

What is the Prognosis after the Surgery?

A complete recovery from a Laparotomy procedure is normally achieved. The prognosis is usually excellent, without any serious complications being noted.

When do you need to call your Physician?

Do contact your physician, if you notice any of the following symptoms:

  • Pain that worsens and swelling around the surgical wound
  • Bleeding or fluid drainage from the surgical wound
  • The occurrence of any symptom that causes uneasiness, such as nausea, vomiting, abnormal swelling within the abdomen, and constipation
  • Signs of an infection
  • Dizziness
  • Muscle aches, headache
  • Fever, feeling sick
  • Complications associated with prescription medications used in treatment

What Post-Operative Care is needed at Home after Laparotomy surgical procedure?

At home, the following post-operative care is recommended, after a Laparotomy procedure:

  • Slowly resume regular/daily activities as soon as possible, which aids in faster recovery
  • Use a heat pad or warm compress to relieve pain due to the incision
  • Resume showering and keep the wound clean and dry. Gently wash the surgical wound with unscented soap
  • Elevate legs while resting, to prevent the formation of blood clots and reduce the possibility of swelling
  • Complete the course of prescribed medication, as advised by your physician
  • Take stool softeners to prevent constipation
  • Take antibiotic medication to help combat or prevent infection, per the physician’s advise
  • Avoid all activities that are physically strenuous for about 6 weeks, or advised by your physician
  • Resume driving about 3 weeks after the procedure, or when advised by your physician
  • After the procedure, nasogastric suction is sometimes required. Individuals are then advised to have to clear liquids following the procedure, until the gastrointestinal tract begins functioning properly. This should be followed by a well-balanced diet, which can aid in a faster recovery

How long does it normally take to fully recover, from the Procedure?

It usually takes approximately 4 weeks to fully recover from the Laparotomy procedure.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

The tissue is taken for further examination and later disposed as per the standard medical procedure.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

  • The tissue removed is processed in the laboratory under a pathologist's supervision.
  • Slide(s) are prepared once the tissue is processed and is examined by a pathologist and a pathology report issued.
  • Depending on the complexity of the case, issue of the report may take anywhere between 72 hours to a week's time

Who will you receive a Bill from, after the Laparotomy surgical procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

  • The outpatient facility or a hospital
  • An anesthesiologist (if anesthesia was administered)
  • A pathologist (if the tissue was sent for analysis)
  • A general surgeon or a obstetrician-gynecologist surgeon

The patient is advised to inquire and confirm the type of billing, before the Laparotomy procedure is performed.

Thanks and Gratitude:

We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.

Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA

Reviewed and Approved by a member of the DoveMed Editorial Board
First uploaded: Aug. 22, 2014
Last updated: Oct. 16, 2018