Laparotomy, Here's What You Should Know

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Laparotomy, Here's What You Should Know
Laparotomy, Here's What You Should Know
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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 diagnostic procedure. Laparotomy is performed by making a large incision in the area around the patient's abdomen, which is preceded by anesthesia

Some examples of conditions that require a 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.

Laparotomy, Here's What You Should Know - Alodokter

Indications and Contraindications for Laparotomy

Laparotomy procedure can be performed in various conditions, such as:

  • Extreme pain in stomach.
  • Gastrointestinal bleeding.
  • Inflammation of the thin lining of the abdominal wall or peritoneum (peritonitis).
  • Tears in the 12-fingered intestine (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 penetration of 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.

Laparotomy Alert

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 the actions taken. It is recommended to rest for 4 weeks or according to doctor's advice so that the overall 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 check, overall physical examination, and other examinations to ensure the patient's condition is ready for surgery.
  • Scanning. X-ray, CT Scan and MRI scans to help the doctor plan the procedure.
  • Blood examination. This examination is done to monitor electrolyte levels, blood sugar, and the function of body organs such as the heart and lungs.

Patients are required to stop smoking or drinking alcohol a few weeks before the laparotomy. Consumption of drugs such as aspirin, ibuprofen, vitamin E, warfarin, clopidogrel, or ticlopidine should also be stopped a week before the scheduled procedure to avoid difficulty 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.
  • Consuming 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 in a state of sleep during the procedure. The doctor will also clean the abdomen 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 arms are 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. Usually, an incision is made in the center 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 linea alba layer. The layer is then split open to reveal preperitoneal fat.
  • The doctor will clamp and lift the peritoneal layer 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 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. The abdominal wall can be sutured using surgical sutures with low absorption (pol y prop y len e) or with good absorption (polydioxanone). Generally, stitches 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 experiences swelling or distension of the intestine, 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. on the seams. The temporary stitches will be strengthened once the swelling has reduced.

After Laparotomy

Shortly after the laparotomy, 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 pain relievers 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, it is necessary to pay attention to good nutritional intake 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.

Laparotomy Complications

Laparotomy, whether emergency or scheduled, carries a risk of complications. Some of the risks that can occur immediately after surgery are:

  • The cessation of intestinal peristalsis (paralytic ileus).
  • Push buildup in body organs (abscess).
  • Infection of the surgical wound.
  • Opening of the seam on the abdominal wall.
  • Formation of a hole in the gastrointestinal 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 experiences blockages due to blood clots in the arms or legs, damage to organs such as kidneys, lungs, spleen, or if there is adhesions in the abdominal cavity.

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