La laparotomy or commonly referred to as " abdominal dissection " is a surgical intervention which consists in open the abdomen by an incision. This opening allows various surgical procedures. Different routes are possible depending on the organ to be operated on.
In what cases is usually indicated abdominal dissection? How does the procedure take place ? What are the potential complications ? What about the postoperative ? The answers in this article.
What is an abdominal dissection?
THEabdominal dissection ou abdominal laparotomy is a surgical act which consists in open the abdomen for operate on one or more organs. Manual incisions are made in the tissues of the abdomen for the purpose of treating an injury or disease. We are also talking aboutopen belly surgery.
It exists several types of incisions in abdominal laparotomy.
The midline laparotomy
La midline laparotomy concerns the abdomen, from the pubis to the sternum. The surgeon makes a vertical incision on the abdomen, starting from the pubis, bypassing the umbilicus, to go to the lower edge of the sternum. This technique allows the surgeon to carefully observe and palpate the entire abdominal cavity. Indeed, the midline laparotomy gives access to the entire cavity of the abdomen.
The vertical laparotomy
La vertical laparotomy relates to the lower part of the abdomen. The incision goes from the umbilicus to the pubis.
The horizontal laparotomy
La horizontal laparotomy takes place at the pubic hairline. This is the Pfannenstiel incision, the one that is frequently made in women giving birth by caesarean section.
The approach must allow access to the target viscus in the most direct and least damaging way possible. The nerves, muscles and vessels must also be taken into account.
Indications for a laparotomy
With the increasing availability of sophisticated imaging techniques, the indications and scope for laparotomy have greatly diminished over time. Additionally, the increasing availability of laparoscopy as a minimally invasive means of abdominal surgery has further reduced the demands.
Nevertheless, the importance of laparotomy as a quick and cost-effective way to manage acute abdominal conditions and trauma cannot be underestimated.
Laparotomy is often indicated in very specific situations.
- When less invasive laparoscopic surgery is not possible or does not allow access to the desired part of the abdomen.
- When the patient has already had a laparotomy in the past. By intervening in the same way a second time, the patient is exposed to health risks, by causing adhesions (that is to say that the organs will be stuck to the wall of the abdomen).
- When the tumors are too big to come out through a small hole (laparoscopy).
It can also be used as part of a bullet wound, penetrating abdominal trauma with hemodynamic instability, evisceration, digestive cancer (when a cancer has invaded an organ other than the organ of origin) or a peritonitis (inflammation of the membrane that lines the abdominal wall and covers the organs of the abdomen).
In addition, many operations also require the opening of the abdomen. We can take as an example the major abdominal surgeries such as the removal of an organ (stomach, pancreas, kidney, etc.), or a liver transplant, but also urological, gynecological, or even aesthetic surgery (large abdominal apron, tummy tucks, etc.).
What are the procedures to follow ?
La laparotomy is an intervention that takes place under general anesthesia, in the vast majority of cases. However, sometimes it is possible to put only the lower body to sleep, but at this time the level of the navel should not be exceeded. It is necessary to operate only under the navel.
La duration of the procedure is variable depending on the type of operation.
The most common approach is the so-called “median” (median laparotomy). The surgeon makes an incision in the middle. The advantage is to be able to pass between the muscles. We are talking about muscle section. It's less dilapidating.
The operation involves making an incision on the white line (midline of the abdomen) without opening the peritoneum (serous membrane that lines the abdominal cavity). This only undergoes a small incision useful to collect the blood and complete the incision of the linea alba from top to bottom.
When the peritoneum is open, the surgeon cuts the round ligament between two ligatures and collects as much blood as possible. It externalizes the hail and controls any obvious bleeding by direct compression. In the event of bleeding in the mesentery, the professional clamps or ligates the vessel.
We then proceed to the actual operation according to the organ in question. For major operations, it is possible to open from the sternum to the pubis.
Once the operation is complete, the surgeon closes the abdomen by suturing first the muscles (if they have been cut), then the fat and the skin using threads, staples or sometimes simply with glue when the incision is minimal. It all depends on where the scar is made, and its length.
What about the postoperative course?
La main recommendation to follow after undergoing a laparotomy is to avoid heavy loads. Some practitioners recommend wearing a compression belt.
In the short and medium term, it is possible to observe complications as'hematoma,infection andevisceration (exit of the organs of the abdomen caused by the disunion of an operative wound). Evisceration represents a medical emergency, it requires a surgical intervention.
As for the operative follow-up, it is different according to the operated organ. After a laparotomy, bowel functions may sometimes be impaired. It expands (swells) a little and gases can accumulate inside. Usually this recovers after a few days.
Analgesics are prescribed to the patient to relieve the pain.
To limit the risk of abscess of the wall of the abdomen, monitoring of the scar is done during the 5 days following the operation.
A post-operative consultation is also scheduled in the 3 to 4 weeks following the intervention.
La recovery time varies in organ function who is operated. If the gallbladder is removed, the patient can return to their home after 3 or 4 days and resume their activities in an almost normal way. On the other hand, the operation for peritonitis with perforation of the colon requires the patient to stay in the hospital for 5 to 15 days. It will take longer to recover.
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