EXPLORATORY LAPROTOMY indications and procedure.pptx

Exploratory Laprotomy

1. Exploratory laparotomy Presented by Roll no : 19003 19004

2. A laparotomy is a surgical procedure involve a incision through the abdominal wall to access into the abdominal cavity. It is also known as celiotomy. explorative Therapeutic need for operation- “+” “+” pre operative diagnosis- “-” “+”

3. INDICATIONS: Acute abdomen due to: Trauma { blunt and penetrating} Infection{ acute and chronic} Removal of foreign bodies Staging laparotomy in malignancy Acute apoplexy As a part of gynecological or urological procedure Complication of laproscopic or endoscopic procedure.

4. PRE OP PREPARATION 5 tube – intravenous lines - nasogastric tube - Urinary catheter - Endotracheal tube - CVP line in intensive monitoring Preop antibiotics Arrangement of blood and blood products.

5. Surgical access into abdominal cavity Midline Para median A long transverse muscle- cutting In case of previous history of laparotomy An attempt should me made to enter the abdomen above or below the previous incision, in an area less likely to have adhesion.

6. POSITION: Patient lie in supine position with arm abducted at right angle to the body. Lithotomy position may be employed instead when a pelvic pathology is suspected and a simultaneous vaginal or rectal intervention is necessary Exploratory laparotomy is perform under general anesthesia .

7. Procedure Upper midline incision. Incision is deepened through subcutaneous tissue to expose linea alba. Linea alba is divides to reveal preperitoneal fat. Abdominal incision is completed to reveal intra abdominal organs.

8. SURVEY OF THE ABDOMEN Divide peritoneal cavity at transverse mesocolon. Supramesocolic Inframesocolic -move transverse colon caudally -lift transverse colon cranially -Inspect and palpate - visualised the pelvis and liver, GB, right kidney female reproductive tract. Stomach to GE junction to diaphragm - Duodenum , lesser sac spleen, left kidney

9. Retroperitoneal exploration : by following maneuver Kochers maneuver - facilitates exploration behind the duodenum and pancreas . Cattle braasch maneuver - facilitate exploration of IVC, SMV , rt renal vessels, abdominal aorta. Mattox maneuver - facilitate exploration of abdominal aorta and left renal vessel.

10. Drains after an exploratory laparotomy Most comman used drains are Open or closed Active or passive Their used should be limited Evacuation of an “established abscess”. Extensive contamination may benefit from drains in subhepatic space and the pelvis. Suction drains may be needed for prevention of blood collections in the peritoneal cavity.

11. . To allow escape of potential visceral secretions ( e.g , biliary ,pancreatic).

12. Abdominal closure Permanent closure “MASS CLOSURE” Using non absorbale /delayed absorbale sutures. 1 cm wide bites. Max 1cm gap between two bites. Ideally suture length to wound length ratio 3:1 Subcutaneous sutures are of no value .

13. Temporary closure/open abdomen Commonly done in DCS. Fascial layer left open with temporary occlusive dressings. Secondary closure may be done after physiological stability is achieved .

14. Damage Control Damage control surgery is one of the major advances in surgical technique. Carried out when there is Terrible Traid of Trauma. Hypothermia. Acidosis. Coagulopathy . Abdomen is packed and patient taken to ICU for resuscitation . Patient is return to theatre within 48 -72 hr for definitive repair.

15. Complications Immediate complications: Abdominal compartment syndrome. Paralytic ileus . Intra- abdominal collection or abscess. Wound infections. Abdominal wall dehiscence. Enterocutaneous fistula. Pseudocellulitis (post op air entrapment).

16. Delayed complications: Adhesive intestinal obstruction. Inscisional hernia.

17. , Thank you