Exploratory Laparotomy

Exploratory laparotomy is a surgical procedure to access the organs in the abdomen, which include:

• Female reproductive organs - womb (uterus), ovaries, and fallopian tubes  (transport the egg from the ovary to uterus) 
• Urinary system organs - kidneys, bladder (storage pouch for urine), and ureters (tubes that carry urine from kidney to the bladder)
• Digestive system organs like the liver, small and large intestines, and stomach
• Appendix (lies at the joining of the small and large intestine)
• Blood vessels 
• Lymph nodes (small nodes that contain immune cells to fight infection) 
• Membranes that line the abdominal cavity

Exploratory laparotomy is an open procedure that involves a large incision (cut) over the abdomen. It is usually performed to diagnose a condition that cannot be identified with diagnostic tests. If the cause is identified through this surgery, the healthcare provider may treat it simultaneously. In an emergency, exploratory laparotomy is conducted to check for any injury to the organs inside the abdomen due to trauma.

Exploratory laparotomy is recommended for the diagnosis and treatment of conditions inside the abdomen. Your surgeon may suggest this procedure if you have problems like abdominal pain or bleeding without a known cause. Some of the conditions that can be identified with an exploratory laparotomy are:

• Pancreatitis
• Ectopic pregnancy
• Adhesions (formation of fibrous/scar tissues inside the abdomen)
• Diverticulitis
• Appendicitis
• Cancer of the liver, pancreas, colon, and ovaries 
• Gallstones
• Abscess or accumulation of pus in the liver, abdomen, pelvis (lower abdominal region), and retroperitoneum (membrane of the abdominal wall) 
• Perforation (hole) in the bowel wall 
• Endometriosis (cells from the inner lining of the uterus grow outside the uterus)

A healthcare provider may perform this surgery urgently to check the following conditions:

• Bleeding within the peritoneum, a transparent membrane lining the walls of the abdominal cavity 
• Uncontrollable bleeding in the stomach and intestine 
• Intraperitoneal sepsis (a serious infection)
• Penetrative or blunt injuries

Exploratory laparotomy is contraindicated in individuals who cannot have general anaesthesia (a sleep-inducing medicine). This usually occurs if you have multiple conditions like sepsis, coexisting medical conditions, your cancer spreads to other parts of the body, and a problem with the blood flow to the organ (haemodynamic instability).

You will need the following preparations before the surgery:

• Your healthcare provider will perform a physical examination and may order a few diagnostic tests like X-ray and blood tests to check your overall health.
• Tell your doctor about all the medicines that you take, including over-the-counter medicines, vitamins, herbs, and supplements. 
• Women should inform the doctor if they are or could be pregnant.
• You will have to fast (no food or drink) from midnight prior to the surgery.
• Avoid taking blood thinners (like aspirin, ibuprofen, and clopidogrel) for a week before the procedure.
• Quit smoking and drinking alcohol to improve your recovery after the surgery.
• Inform your healthcare provider if you have any allergies or bleeding problems.
• Arrange for a friend or family member to take you to the hospital and bring you back after the procedure.
• You will have to sign an approval form to grant permission for the surgery.

When you reach the hospital, the medical team will give you a hospital gown to change into. You may receive an enema to empty your bowels and an IV catheter will be inserted in your arm or hand to supply medicines and fluid during the surgery. 

An anaesthetist will inject general anaesthesia through an IV line. You will be attached to various machines so your vital functions like blood pressure and heart rate can be continuously monitored during the surgery. 

A tube will be placed inside your throat through your mouth to assist in breathing. A catheter (tube) will also be inserted into your bladder to drain urine.

In the operation theatre, the surgeon will perform the following steps:

• He/she will clean your abdominal skin with an antiseptic solution and make a large cut on the skin to access the inside of your abdomen. The location of the cut may vary based on the organ to be viewed. For example, an incision will be made in the lower belly to check the female reproductive organs (pelvic cavity).
• Next, the surgeon will check the exposed organs for the health condition or injury.
• He/she may collect a tissue sample from the operated area and send it to the laboratory for biopsy.
• Once the condition is known, the surgeon may treat or remove the damaged organs right away.
• Thereafter the surgeon will place a drainage tube in your abdomen to remove any accumulated fluids.
• Finally, he/she will close the incision with stitches (absorbable or nonabsorbable) or staples and cover it using a bandage.

This procedure may last for one to four hours. After the operation, you will be taken to the recovery area. You will stay in the hospital for some days, during which:

• Your health will be closely monitored.
• Once you are awake, the hospital staff will move you to a hospital room.
• Painkillers and antibiotics (to reduce infection) will be given to you if required. 
• The tube inside your bladder and throat and the drainage tube will be removed a few days after surgery. 
• You will be supplied with liquids through the IV line till your bowels start working again.
• As you recover, you will be encouraged to get up and walk around a bit. This will help reduce the risk of blood clots. A nurse will assist you in walking until you can on your own.

It will take about four weeks to recover from the surgery completely. In the recovery period, you should take the following care at home:

• Wound care:
  • Keep your wound dry for at least two days after the surgery. You can take a shower after that.
  • Avoid soaking in a bathtub or swimming for some days following the procedure. 
  • Change the bandage 24 hours after the surgery.  
• Medications:
  • You will be given medicines to reduce post-surgical pain. Take them as directed. 
  • Your doctor will also suggest you to take laxatives (to prevent constipation) and anti-sickness medications (to prevent vomiting). 
• Activities: 
  • You may need a few months to resume your routine completely. 
  • Avoid lifting heavy objects for four to six weeks.
  • Keep yourself active by taking a walk daily. 
  • Avoid sexual intercourse for at least six weeks after the surgery. 
  • Do not indulge in activities like excessive stretching or pushing. Also, avoid heavy housework like mopping until your surgeon allows you to. 
• Driving: Your surgeon may ask you to wait for at least six weeks before starting to drive after the surgery. 
• Diet: 
  • Eat a fibre-rich diet to avoid the risk of constipation. 
  • Drink at least eight glasses of water each day. 
  • Do not take alcohol while you are on painkillers.

When to see the doctor?

Call or visit your surgeon immediately if you experience the following symptoms after the surgery:

• Fever 
• Chills 
• Persistent nausea and vomiting 
• Difficulty in urinating
• Pain even after taking medicines
• Chest pain 
• Pain, redness, and swelling in the legs 
• Swelling or hardness in the abdomen 
• Diarrhoea or constipation for over three days 
• Dizziness or fainting 
• Shortness of breath 
• Swelling, redness, discharge, or bleeding from the incision site
• Dark black or red-coloured stools 
• Cough

This surgery is known to carry the following risks:

• Hernia 
• Bleeding 
• Bowel blockage 
• Infection 
• Necrosis (tissue death) 
• Bruising
• Scar tissue in the abdomen 
• Numbness of the skin
• Damage to nearby organs (to the one operated on) in the abdomen
• Blood clots 
• Reactions to anaesthesia like sore throat or wheezing

You will have a follow-up appointment 10 to 14 days after surgery to get the nonabsorbable stitches or staples removed. During the appointment, your surgeon will also assess the healing of your wound.

Disclaimer: The above information is provided purely from an educational point of view and is in no way a substitute for medical advice by a qualified doctor.