Generality

The term "laparotomy" is used to indicate the set of all surgical techniques performed by making an incision along the abdominal wall, so as to be able to intervene directly in the abdominal cavity and in the organs contained within it.

Types of Laparotomy

Depending on the abdominal area where surgery is required, the surgeon will perform the type of laparotomy that best suits each case.

Basically, there are three different types of laparotomy, which differ from one another in the way in which the abdominal incision is made:

  • Vertical laparotomies, when the incision made on the abdomen is, in fact, vertical. The vertical laparotomies can, in turn, be divided into:
    • Xipho-umbilical incision;
    • Navel-pubic incision;
    • High trans-rectal incision;
    • Low para-rectal incision.
  • Transverse laparotomies, when the incisions are horizontal. In particular, this type of laparotomy is used in pancreatic and adrenal surgery (the form used is the bilateral subcostal incision of Ross) and in obstetric-gynecological surgery (in this case, the form used is the lower transverse incision of Pfannestiel).
  • Oblique laparotomy, in which the incision on the abdomen is made obliquely. In this case, we can distinguish:
  • Subcostal incision of Kocher;
  • McBurney's iliac incision.

Criteria for choosing the type of Laparotomy

The choice of the type of laparotomy to be performed is up to the surgeon, who will have to take into account several parameters, such as:

  • The organ on which it is necessary to intervene, since it is necessary that the incision allows the optimal exposure of the latter;
  • The type of pathology that must be treated and its severity;
  • The presence of blood vessels, nerve structures or Langer lines in the area where intervention is required;
  • Possible complications that may occur during surgery and that could put the surgeon in the condition of having to make other incisions;
  • Simple suturing to be performed at the end of the procedure. In fact, the laparotomy must be performed in such a way as to allow a simple and rapid reconstruction of the incised part, so as to avoid - as far as possible - the onset of any complications and to try to limit the post-operative pain perceived by the patient .

The surgeon, therefore, will from time to time evaluate which type of laparotomy to use, taking into account both the aforementioned evaluation criteria and the conditions of the patient to be operated on.

However, it should be remembered that depending on the type of surgical operation to be performed, there are "characteristic" laparotomies for each operation. For example, there is a specific laparotomy for the treatment of appendicitis, gastric ulcer, bladder stones and so on.

Method

Once the patient has been prepared for the surgery and once disinfected (through the use of appropriate antiseptics) the area at which the laparotomy must be performed, the surgeon can proceed with the surgery.

Indicatively, the laparotomy procedure can be divided into three phases:

  • Opening : in this phase the surgeon performs the incisions necessary to reach the organ or in any case the body district on which it is necessary to intervene. Initially the skin and the subcutis are etched, to then continue with the muscles and finally reach the peritoneum.
  • Closure : at the end of the laparotomy, the surgeon will have to proceed with the reconstruction and suturing of the incised area. In this case, we will proceed by suturing the peritoneum first (generally, with resorbable material), then the muscles are sutured and, finally, subcutaneous and skin (in the latter case, natural or synthetic non-absorbable threads can be used; staples can be used).
  • Placement of drainage : in some forms of laparotomy, at the end of the surgery it may be necessary to insert an endo-abdominal drainage, to favor the elimination of any physiological or pathological fluids that may be formed.

Results and Convalescence

Generally, laparotomy is a valid and effective procedure that - if correctly performed - gives excellent results.

However, compared to other less invasive surgical techniques (such as laparoscopy), laparotomy involves a longer period of convalescence and prolonged healing times. In fact, generally, for patients undergoing laparotomy it is advisable to stay at rest avoiding physical efforts of any kind for at least 3-4 weeks.

However, the necessary rest and recovery times vary according to the type of laparotomy the patient underwent, the onset of any post-operative complications and the patient's condition.