Laparotomy

What is a Laparotomy?

Laparotomy, also called abdominal exploration, is an operation that is performed to view the inside of the abdomen and its organs to help diagnose the cause of complaints such as abdominal pain. This operation is done through a surgical cut in the abdominal cavity. Once the issue is identified, it is fixed, if possible, during  the  laparotomy. A second operation may be needed to resolve the condition in some cases.

Pre-surgery care

Before beginning the operation, the doctor will:

• Conduct tests to make sure the patient will be able to tolerate surgery
• Perform a complete physical examination
• Ask the patient to discontinue smoking a few weeks before the surgery if they smoke
• Make sure medical conditions such as high blood pressure, diabetes, lung or heart problems, are under control before the surgery
• Advise the patient to stop taking blood-thinning medications like vitamin E, clopidogrel, ticlopidine, ibuprofen, and warfarin temporarily

To prevent any complications, the doctor should be informed of:

• Any prescribed and non-prescribed supplements, herbs, vitamins, or medications
• Alcohol intake of more than one to two drinks in a day
• The possibility of a pregnancy

Precautions on the day of surgery:

• Arrive at the hospital on time for surgery
• Follow the doctor’s instructions and stop eating and drinking as advised
• Take the pre-surgery medications with small sips of water

Laparotomy procedure

• Anesthesia will be given just before surgery.
• An incision through the skin and muscles of the abdomen will be taken to view all the organs, tissues, internal blood vessels, and fluids carefully to detect the cause of the condition under investigation.
• The abdomen will be checked for any evidence of abnormal growths, perforations, infections and inflammations or metastases (spread of cancer cells).
• A sample tissue biopsy will be taken if required.
• A treatment procedure is carried out if possible, and the incision closed with staples or sutures. A drain is placed in the abdominal cavity to remove excess fluid.

Post-surgery care

The following care will be taken while in the hospital after the surgery:

• A drain may be placed to drain out excess fluid.
• Blood pressure, pulse rate, breathing pattern and the wound are monitored carefully.
• The stomach secretions may be drained out through the nose with a tiny tube for a day or two to provide rest to the digestive tract.
• A urinary catheter may be inserted to drain urine.
• Intravenous fluids (fluids directly delivered to the vein) will be administered.
• Medications will be provided to ease the pain.
• Wound care will be provided, and the patient will be kept under observation.
• The patient will be asked to walk at the earliest after the surgery to lower the risk of chest infections and blood clots.
• Medications and instructions for wound care at home will be given at discharge.
• A follow-up appointment will be set.

Post-surgery care at home

Following are some do’s and don’ts once you are home after the laparotomy:

Do’s

Rest well and enough: About two weeks after the laparotomy, you can slowly start doing more work, and by six weeks, you can get back to normal levels of activity. In this duration, you can carry out light activities like dusting and making a cup of tea. Instead of lifting your children, allow them to climb on your lap while you are sitting.

Exercise: You might be seated most of the time, but too much sitting can cause swelling in your feet or ankles. It can also increase your risk of deep vein thrombosis (formation of blood clots in the veins of your legs). You may feel tired while exercising, so remember to increase the time and sets of your exercises gradually. Continue to perform the exercises taught by the physiotherapist. You may even swim after six to eight weeks when your wound has healed entirely.

Eat healthy: Follow a healthy and balanced diet to accelerate your healing process. Some healthy foods you can include in your routine are:

Fiber-rich foods like beans, bran flakes, beans, wholemeal bread. These aid with constipation, one of the possible side effects of medications
Plenty of fluid intake, at least eight glasses of water or non-sugary drinks, every day
Protein-rich foods like meat, hearty greens, fish, eggs, pulses and beans

Fresh fruits and veggies
Consult your physician if you have a poor appetite after the surgery

Drive extra carefully

If you have someone to drive you, it is totally fine. However, if you plan to drive, especially for long distances, stretch your legs at regular intervals. Make sure you drive only when:

You are comfortable in applying emergency breaks and stopping the vehicle suddenly.
You have stopped medications that can affect your driving ability
You have an insurance cover
You can entirely concentrate on the drive

Wound care

Even if your wound has not healed and you still have paper strips, staples, or clips on your wound, continue to bathe or shower daily to prevent the risk of infection. Use unperfumed soaps. After bathing or showering, dry yourself with a dry and clean towel.
If you have a closed wound, keep it uncovered for it to heal better
Use medications as per your doctor’s instructions
Resume work when you feel ready

Don’ts

Avoid the following tasks immediately after surgery:
Lifting heavy objects
Playing strenuous sports
Too much of stretching, pulling or pushing
Heavy household chores like mopping floors, vacuuming, and ironing
Do not carry a weight of more than three pints for up to 12 weeks after your surgery
Do not do exercise rigorously
Do not use any ointment or cream on the wound site unless instructed by your doctor
If you experience vaginal bleeding or discharge, do not use tampons as they may increase your risk of acquiring a vaginal infection. If you use sanitary pads, make sure to change them often

Complications of laparotomy

The possible complications after laparotomy are:

• Complications from general anesthesia like vomiting, sore throat, fatigue, muscle soreness, headache, and nausea
• Allergic reactions
• Changes in blood pressure levels
• Stroke
• Heart attack
• Chills
• Fever
• Bleeding in the rectum
• Severe pain in the abdomen

Complications that are linked to the laparotomy procedure are:

• Internal bleeding
• Leakage from the colon
• Injury to adjacent internal organs like the bladder and small intestine

References:

https://www.qegateshead.nhs.uk/sites/default/files/users/user1/leaflets/IL337%20Discharge%20advice%20following%20laparotomy.pdf
http://www.afg.org.in/dtevents_news/consent_afg2014.pdf
https://medlineplus.gov/ency/article/002928.htm
https://www.healthdirect.gov.au/laparotomy
https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/laparotomy
http://www.uhs.nhs.uk/Media/Controlleddocuments/Patientinformation/Surgery/Emergencylaparotomy-patientinformation.pdf
https://www.acog.org/Patients/FAQs/Laparoscopy

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