Laparotomy is a medical procedure that aims to open the abdominal wall in order to have access to the abdominal organs that require certain procedures or as a procedure procedure diagnosisstick. Laparotomy is done by making a large incision in the area around the patient's abdomen, which is preceded by anesthesia.
Some examples of conditions that require laparotomy as part of the treatment are intestinal blockage or obstruction, intestinal perforation or leakage, abdominal bleeding, and sometimes for the removal of malignant tumors around the abdomen. This laparotomy can be performed as an emergency operation if the patient's condition is critical, or it can be scheduled after obtaining the results of the related examination.
Indication and ContraindicationsLaparotomy
Laparotomy procedures can be performed under various conditions, such as:
- Severe pain in the stomach.
- Gastrointestinal bleeding.
- Inflammation of the thin lining of the abdominal wall or peritoneum (peritonitis).
- Tear in the 12 finger intestinal organ (doudenum), stomach, small intestine, or other abdominal organs.
- Diverticulitis, appendicitis, or inflammation of the pancreas.
- Gallstone disease.
- Trauma or abdominal injury with hemodynamic instability or penetrating sharp objects.
- Cancer or malignant tumor of the organs in or around the abdominal cavity.
- Liver abscess.
- Adhesions in the abdominal cavity.
- Ectopic pregnancy (outside the uterus).
- Growth of endometrial tissue outside the uterus (endometriosis).
Contraindications that need to be considered are incompatibility with certain anesthetic drugs, generally in patients with sepsis, malignant tumors, and other critical conditions. Tell your doctor about your condition so that actions and medications can be adjusted.
Warning Laparotomy
If you are going to perform a laparotomy procedure, the doctor who treats you will consult an anesthesiologist to avoid the negative effects of anesthetic drugs.
Shortness of breath, bleeding, blood clots, and infection are risks that can occur as a reaction to drugs and actions taken. It is recommended to rest for 4 weeks or according to doctor's advice so that the complete recovery process runs quickly. You are not allowed to drive a vehicle during the recovery process, so it is advisable to contact your family or relatives to drive you home after surgery.
Before Laparotomy
Some of the examinations that the doctor may do before the laparotomy procedure are:
- Physical examination. Generally includes blood pressure checks, overall physical examination, and other examinations to ensure the patient's condition is ready for surgery.
- Scanning. X-ray examination, CT Scan and MRI to help doctors plan the procedure.
- Blood test. This examination is carried out to monitor electrolyte levels, blood sugar, and the function of organs such as the heart and lungs.
Patients are required to stop smoking or drinking alcohol a few weeks before the laparotomy. Take medications such as aspirin, ibuprofen, vitamin E, warfarin, clopidogrel, or ticlopidine should also be discontinued a week before the scheduled procedure to avoid difficulty in clotting blood around the surgical area. Some additional suggestions that may be given before performing a laparotomy to avoid intestinal infections include:
- Eat high-fiber foods such as vegetables, fruit, bread, and whole grain cereals a day or two before the operation.
- Consume 6 to 8 glasses of water a day.
- Take laxatives to cleanse the intestines. This medicine will trigger diarrhea.
Laparotomy Procedure
The initial preparation that the doctor will do to the patient in the operating room is to give anesthesia and empty the intestines to avoid excess stomach acid using a catheter. Anesthesia drugs are generally given through intravenous fluids so that the patient is always asleep during the procedure. The doctor will also clean the stomach with soap before the operation.
The following is the order of the laparotomy procedures:
- The patient will be lying on the operating table in a supine position and the arm is positioned on the right side of the body.
- After that, the doctor will make a vertical incision in the middle, top, or bottom of the abdomen. The size of the incision will be adjusted to the patient's condition and the action to be performed. Generally, an incision is made in the middle of the abdomen to make it easier to reach the membrane lining the stomach (peritoneum) and reduce the risk of bleeding.
- After the main incision is made, the doctor will make a deeper incision through the subcutaneous fat to the layers linea alba. The layer is then split open until it looks fat preperitoneal.
- The doctor will clamp and remove the lining peritoneum using forceps, near the incision line. This stage will be done slowly so as not to injure the intestines or other organs.
- The next stage is to do exploration. Here the doctor will check for bleeding, tears, injuries, tumors, or other abnormalities of internal organs. Follow-up procedures such as cleaning and flushing the abdominal cavity using a catheter, suturing the leaking organ, or removing the tumor, will be performed.
- After the entire process is done, the doctor will examine the condition of the abdominal organs and surrounding areas before sewing them back on. Abdominal wall can be sutured using surgical thread with absorbency low (polypropylene) or with good absorption (polydioxanone). Generally, the suture will be started at a distance of 1 cm from the end of the linea alba, followed by sewing between the incisions made.
- If the patient has intestinal swelling or distension, the doctor will perform temporary suturing to avoid postoperative complications such as increased intra-abdominal pressure (IAP), breathing problems due to pressure on the diaphragm and chest cavity, abdominal pain, or tearing of the sutures. These temporary stitches will be strengthened once the swelling has reduced.
After Laparotomy
Shortly after the laparotomy was performed, the patient will be transferred to the treatment room for further observation. For patients who have an emergency laparotomy, the doctor may transfer the patient to the ICU for intensive monitoring. The doctor will give you painkillers such as: paracetamol or morphine, according to the level of pain experienced. Antiemetic drugs will also be given to reduce bloating and nausea. Physiotherapy and light exercise may be recommended, especially for patients undergoing emergency laparotomy to restore strength and avoid the risk of blood clots. The patient will be asked not to move much, before the doctor allows.
At the time of recovery, good nutrition needs to be considered so as not to burden the digestive function. If the patient is unable to consume any food or drink, the doctor will give intravenous fluids as a substitute for food.
Immediately consult a doctor if the patient feels fever and severe pain after surgery.
Complications Laparotomy
Laparotomy, whether emergency or scheduled, carries a risk of complications. Some of the risks that can occur immediately after surgery are:
- Cessation of intestinal peristalsis (paralytic ileus).
- Accumulation of pus in the organs of the body (abscess).
- Infection in the surgical wound.
- Opening of the suture on the abdominal wall.
- Formation of a hole in the digestive tract (enterocutaneous fistula/ECF).
- Collapse of the lung due to blockage of the bronchi or bronchioles (pulmonary atelectasis).
- Incisional hernia.
- Intestinal obstruction.
- Bleeding
Quick treatment needs to be done if the patient has blockages due to blood clots in the arms or legs, damage to organs such as the kidneys, lungs, spleen, or if there is adhesions in the abdominal cavity.
