A laparotomy is literally an “incision in the abdomen,” usually through the flank. This surgical procedure can be performed diagnostically or therapeutically, depending on a patient's situation, and it is typically done by a general surgeon. When laparotomies are performed, the patient is given general anesthesia, as the procedure is quite invasive, and the patient would be extremely comfortable if he or she was awake.
In a diagnostic laparotomy, also known as an exploratory laparotomy or ex-lap, the surgeon opens the patient up to see what is going on inside the body. This type of exploratory surgery can be used to look for a cause for a medical problem, to learn more about abnormalities seen in medical imaging studies, and for treatment of issues like gunshot wounds and hemorrhage, in which the abdomen needs to be opened up to see the source of the problem and correct it. In some cases, the general surgeon may work with a specialist such as an oncologist so that abnormalities seen in the course of the laparotomy can be addressed promptly.
In a therapeutic laparotomy, the incision is made to gain access to the abdomen for the purpose of a medical procedure. In some cases, it may be possible to perform a laparoscopic procedure, in which instruments are inserted through small incisions in the skin and the inside of the abdomen is viewed with a camera. This option is much less invasive, but it can be limiting for the surgeon, and there may be situations in which a laparoscopy is scheduled, but a surgeon ends up needing to perform a laparotomy to see more clearly or to remove diseased tissue.
Prior to a laparotomy, the patient will be interviewed and tests will be run to confirm that he or she is a good candidate for surgery. The surgeon will meet with the patient to talk about the reason for the procedure and potential complications which may emerge, and the patient also meets with the anesthesiologist who will be administering the anesthesia. After the procedure is over, the patient will be taken into a recovery area and monitored.
The recovery time from a laparotomy can be extensive, because the incision may be quite large. Pain management is very important, especially in the early days, and the patient may be required to rest to avoid straining the incision. Commonly temporary adjustments to the patient's diet are made, and he or she is monitored closely for signs of infection and other complications.