Laparotomy

Laparotomy (open, abdominal surgery) is a type of surgical access in which the tissues of the anterior abdominal wall are dissected layer by layer to gain access to the abdominal and pelvic organs. There are several types of incisions when performing an open surgery. In gynecology, a horizontal incision in the suprapubic region (Pfannenstiel laparotomy) 10−12 cm long is most often used. However, the type of incision depends on the reason for which the surgery is required, or more precisely, on the size of the organ being operated on and the urgency of the surgery. In the case of large uterus or pelvic organ formations, as well as in the case of an emergency need for surgery (bleeding), a vertical lower midline incision (from the navel to the suprapubic region) is used.

The most common types of incisions in gynecologic surgeries are as follows

Currently, laparotomy in gynecology is performed less and less often, because in most cases it can be replaced by laparoscopic access. However, there are situations when laparoscopy cannot provide sufficient safety and speed of surgery.

Indications for laparotomy are:

1

Urgent operations with large blood loss
2

Large uterine fibroid (usually when the uterus is larger than 16−18 weeks of pregnancy); multiple fibroids or with a complex arrangement of nodes, when the uterus is immobile in the pelvic cavity
3

Large ovarian tumors (more than 15 cm)
4

Extensive adhesions in the abdominal and pelvic cavities after previous laparotomies or in severe purulent-inflammatory diseases, when the probability of an adhesive process is extremely high
5

Lack of surgeon’s skills in endoscopic operations and/or equipment to perform them

Abdominal surgeries are performed both under general (endotracheal) anesthesia and under regional anesthesia (spinal). The decision on one or another type of anesthesia is made by the anesthesiologist after a preoperative examination, taking into account many factors.

Before the surgery, patients are advised to adhere to dietary restrictions: a low-fiber diet should be followed for 3 days prior, the last meal should be no later than 23:00 on the day before the surgery, and water can be drunk until 6:00 a.m. on the day of surgery.

Also, in the postoperative period, for 2−3 days, it is advisable to limit foods that cause bloating and the formation of dense feces. If there is a suspicion of intestinal involvement in the pathological process and the possibility of working with it during surgery (for example, with intestinal endometriosis), the doctor may ask to prepare the intestines for surgery using laxatives.

Activation is usually carried out a few hours after surgery if the patient’s condition is satisfactory and there are no contraindications, or in the morning of the next day. During activity, it is necessary to wear a postoperative bandage to relieve pain and reduce the load on the anterior abdominal wall in the early postoperative period. In addition to the bandage, it is recommended to wear compression stockings for 2−3 weeks after surgery to prevent thromboembolic complications.

Discharge is usually carried out on the 3rd-5th day after the surgery, however, the doctor determines this period individually.

Removal of sutures from the anterior abdominal wall is often not required, since an intradermal running cosmetic suture is usually placed, which dissolves over time. However, sometimes, in a case of single sutures, it is necessary to remove them 7−10 days after the operation.

All patients are recommended to exclude physical activity for 1−2 months, adhere to sexual rest from 2 to 8 weeks, depending on the type of the operation. Other recommendations are prescribed by the surgeon individually.

Any use of site materials is possible only with the written permision of its owner.

Contacts

Menu

Koval.al.al@gmail.com