Laparotomy – opening and closing

Brief powerpoint on how to open and close the abdomen for laparotomy. Directed to junior surgeons.

1. Laparotomy – opening and closing Mr Maheshwar Naidoo FCS(SA) Ngwelezana Hospital South Africa

2. Watch Video 8 minutes VTS_03_1.VOB (“How to Operate”) Reading material Farqharsons 10 th Ed, Chapter 13, pages 209-225 Scott-Conner and Dawson, 4 th Ed, Chapter 44, Pages 246 -255 SRB’s surgical operations: Text and Atlas, Chapter 3, Pages 34 - 67 How to Operate - For MRCS Candidates and Other Surgical Trainees DVD (3 DVD Set)

3. How many different laparotomy incisions are there? A= Vertical midline B= paramedian C= gridiron D= Lanz / Rockey Davis E= Pfannenstiel F= Suprapubic G= Transverse upper abdominal H= Subcostal (Kocher incision) I= Oblique iliac muscle cutting incision J = Chevron / Rooftop/ bilateral subcostal incision LAPAROTOMY IS A MISNOMER. Correct technical term is a celiotomy . J

4. Position of patient Name of this position? Lithotomy? Lloyd Davis For laparotomy Supine Position of patient’s upper limbs? Foley catheter? NGT? DVT prophylaxis? NO contact between patient’s skin and any metal object Pressure necrosis prevention Avoid leaning on the patient Ergonomic position and posture of surgeon

5. Midline laparotomy incision – layer by layer L External oblique Internal oblique Transversalis muscle Linea alba Sheath layers above umbilicus Sheath layers below umbilicus

6. Cleaning and draping/ operative tray

7. Exploratory laparotomy

8. Abdominal closure As per video but use toothed Bonney/ Ramsey forceps rather than hands Skin – reserve skin clips for SSG

9. Review in SOPD ROS as local clinic

10. Open abdomen =LAPAROSTOMY Complication of a “Bogota Bag”

11. End questions