Laparotomy

The procedure is tailored to the underlying condition and urgency:

1. Before Surgery Evaluation:
   
   • Diagnosis:
     
     • Clinical exam: Abdominal tenderness, distension, or signs of shock (e.g., hypotension in trauma).
     • Imaging: Ultrasound (e.g., FAST for trauma), CT scan, or X-ray (e.g., free air indicating perforation).
     • Blood tests assess hemoglobin (for bleeding), infection (e.g., WBC, CRP), and organ function (e.g., creatinine, liver enzymes).
   • IV fluids, blood transfusions, and broad-spectrum antibiotics (e.g., piperacillin-tazobactam) stabilize the patient.
   • Consent is obtained, explaining the exploratory nature if the diagnosis is unclear.
2. Surgical Techniques:
   
   • Exploratory Laparotomy:
     
     • Performed under general anesthesia, lasting 1–4 hours depending on the complexity.
     • A midline incision (10–20 cm) is made from the xiphoid process to the pubis, providing wide access.
     • In trauma, a shorter incision may be used initially, extended as needed.
     • The peritoneal cavity is entered, and free blood, pus, or bowel contents are suctioned.
     • Systematic exploration: The surgeon examines the liver, spleen, stomach, intestines, and other organs for injury, perforation, or pathology.
   • Specific Interventions:
     
     • Trauma: Control bleeding (e.g., splenectomy, liver packing), repair bowel perforations, or resect non-viable tissue.
     • Perforated viscus: Repair (e.g., suture a perforated ulcer) or resection (e.g., colectomy for perforated diverticulitis).
     • Tumor resection: Remove cancerous tissue (e.g., hemicolectomy for colon cancer) with lymph node sampling.
     • Obstruction: Relieve blockage (e.g., adhesiolysis, small bowel resection).
   • Wound Closure:
     
     • The abdomen is irrigated with saline to reduce infection risk.
     • A drain may be placed to manage fluid or pus.
     • The incision is closed in layers (peritoneum, fascia, skin) with sutures; in cases of contamination (e.g., peritonitis), the skin may be left open for delayed closure (3–5 days).
   • Damage Control Laparotomy:
     
     • In unstable patients (e.g., trauma with shock), the surgery is abbreviated: Bleeding is controlled, contamination is managed, and the abdomen is temporarily closed with a vacuum dressing or Bogota bag.
     • Definitive repair occurs 24–48 hours later after ICU resuscitation.
3. After Surgery:
   
   • Patients are monitored in the ICU (1–3 days for emergencies) or ward (3–7 days for elective cases).
   • Pain is managed with IV analgesics (e.g., morphine) for 2–3 days, then oral medications (e.g., paracetamol).
   • Antibiotics continue for 5–14 days if infection was present.
   • Nasogastric tube (if used) is removed once bowel function returns (e.g., passing gas, 2–5 days).
   • Drains are removed when output is minimal (<50 mL/day).