Exploratory laparotomy

1. Exploratory Laparotomy
Dr Imran Javed.
Associate Professor Surgery.
Fiji National University.

2. Indications
•Acute Abdomen due to:
•1-Trauma (Blunt & Penetrating).
•2- Infections (Acute & Chronic).
•3- Malignancy ( Treatment, Diagnosis & dealing with
Complications).
•4- As a part of Gynecological or Urological
Procedures.
•5- Complicated Laparoscopic or Endoscopic
Procedure.
•6- Removal of Foreign Bodies like dislodged
copper T.

3. Position.
•The patient is placed in the supine position,
with the arms abducted at right angles to the
body.
•The lithotomy position may be employed
instead when a pelvic pathology is suspected
and a simultaneous vaginal or rectal
intervention is necessary.

5. Preop Prepration
•4 Tube Principle:
•1- Intravenous Line
•2- Urinary Catheter.
•3- Endotracheal tube.
•4- CVP line in intensive monitoring.
•Preop Antibiotics.
•Arrangement of blood & Blood products.

6. Anesthesia.
•Exploratory laparotomy is performed with the
patient under general anesthesia.
•Patients who are anesthetized for emergency
surgery are at higher risk for aspiration of
gastric contents. Adequate care must be taken
to empty the stomach before induction.

7. Upper midline incision. Incision is
deepened through subcutaneous tissue to
expose linea alba.

8. Linea alba is divided to reveal pre-
peritoneal fat.

9. Abdominal incision is completed to
reveal intra-abdominal organs.

10. Laparotomy in patient with peritonitis.
Image shows perforated duodenal ulcer.

11. Laparotomy in patient with intestinal
obstruction

12. Sigmoid volvulus with gangrene.

13. Multiple omental deposits in patient with
disseminated carcinoma of stomach.

14. Multiple metastatic deposits over small
bowel in patient with colonic malignancy

15. Liver laceration in traffic accident victim
who presented with hemoperitoneum

16. Drains after an exploratory laparotomy
•Patients with extensive contamination may
benefit from drains in the subhepatic space
and the pelvis.
•Suction Drains may be needed for prevention
of blood collections in the peritoneal cavity.
•Gravity Drains are placed for most of the
routine procedures.
•Sump Drainage in cases of necrotizing
Pancreatitis.

18. Single-layer mass closure
•Closure is carried out with either
nonabsorbable suture material (eg,
polypropylene) or a delayed absorbable
suture material (eg, polydioxanone) in either a
continuous suture or interrupted sutures. The
standard approach is to place sutures about 1
cm from the edge of the incised linea alba,
maintaining a distance of 1 cm between
successive bites.

19. Complications of Procedure
•Immediate complications:
•Paralytic ileus
•Intra-abdominal collection or abscess
•Wound infections
•Abdominal wall dehiscence
•Pulmonary atelectasis
•Enterocutaneous fistula
•Delayed complications :
•Adhesive intestinal obstruction
•Incisional hernia