Why Is an Exploratory Laparotomy Done?

An exploratory laparotomy involves opening the abdominal cavity to see the extent of damage inside, remove any leaking gastric contents and fix injuries. This is often done in trauma emergencies, but also for some bowel cancers, depending on their progression.

An exploratory laparotomy is an open surgical procedure for visual examination of the abdominal organs, tissue and blood vessels. An exploratory laparotomy is often an emergency procedure for patients with acute abdominal pain from disease or injury to the abdomen.

With the availability of sophisticated imaging technologies and laparoscopy, the need for an exploratory laparotomy has diminished. Nonetheless, it is a valuable procedure for acute abdominal conditions.

The primary purpose of an exploratory laparotomy is to identify the cause of acute abdominal pain and treat it. An exploratory laparotomy is generally performed only in an emergency or after other less invasive methods have not been successful in diagnosis. 

An exploratory laparotomy may often be converted into a therapeutic procedure. An exploratory laparotomy is usually performed when there is suspected 

• Abdominal bleeding
• Abdominal infection
• Injury to the abdominal organs
• Bowel or colon perforation
• Intestinal obstruction
• Collection of gastric contents in the abdominal cavity
• Ectopic pregnancy
• Endometriosis
• Appendicitis

An exploratory laparotomy may also be done for other purposes, such as to stage an ovarian cancer or Hodgkin disease. 

A general or specialized surgeon usually performs an exploratory laparotomy under general anesthesia in the hospital operation theatre.

Preparation

Before the surgery, the patient:

• Undergoes a physical examination, and blood, urine and imaging tests.
• Ideally, must not eat or drink anything for 8 hours prior to the surgery.
• Must inform the doctor of any allergies.
• Must check with the doctor before taking any regular medications.
• Must empty their bladder and bowel.

Procedure

• The anesthesiologist administers anesthesia and monitors the vital functions during the surgery.
• The surgeon usually inserts a tube through the nose into the stomach to decompress the stomach.
• The surgeon also inserts a urinary catheter to decompress the bladder.
• The surgeon makes a vertical midline incision in the upper, middle or lower stomach wall depending on the expected source of the pain.
• The surgeon carefully opens up the lining of the abdomen (peritoneum).
• If there is blood, bodily fluids, or gastric contents present in the abdominal cavity, the surgeon will suction them out.
• The surgeon systematically inspects every organ in the abdominal area for damage or disease.
• Depending on the findings, the surgeon performs all possible remedial treatments required.
• The surgeon may remove tissue samples for biopsy.
• The surgeon closes the incision with sutures.

Post-procedure

• The anesthetist will slowly wean the patient off anesthesia.
• The patient will be under observation for several hours in the recovery room.
• Pain medication will be administered for postoperative pain.

An exploratory laparotomy may involve five to 10 days of hospitalization, but this varies widely with individuals. The recovery period depends on the severity of the underlying condition and the complexity of the surgery. Some may need additional treatments or surgeries, which could extend their hospital stay.

An exploratory laparotomy is a major surgical procedure potentially involving several vital organs. The risks are higher for malignant diseases and serious trauma. Risks and complications include:

Anesthetic side effects such as

• Headache
• Nausea
• Confusion

Surgical risks such as

• Infection
• Pneumonia
• Bleeding
• Blood clots
• Organ damage
• Collapse of the lung (pulmonary atelectasis)
• Reaction to medications
• Wound infection and sepsis
• Paralysis of intestinal muscles (paralytic ileus)
• Opening of stomach wall sutures (abdominal wall dehiscence)
• Abscess or collection of pus or fluid in the abdomen
• Abnormal connection between the intestine or stomach and the skin (enterocutaneous fistula)
• Adhesions in the intestines causing obstruction
• Incisional hernia
• Death

Wound infections are the most common complication after an exploratory laparotomy, especially if there is gastric content leakage. Death rate is high in laparotomy performed in cases of trauma because of hemorrhage.