A laparotomy is a surgical Surgery is a medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, to help improve bodily function or appearance, and sometimes for religious reasons. An act of performing surgery may be called a surgical procedure, operation, or simply procedure involving an incision through the abdominal In vertebrates such as mammals the abdomen constitutes the part of the body between the thorax (chest) and pelvis. The region enclosed by the abdomen is termed the abdominal cavity. In arthropods it is the most distal section of the body which lies behind the thorax or cephalothorax wall to gain access into the abdominal cavity The abdominal cavity is the body cavity of the human body that holds the bulk of the viscera. It is located below (or inferior to) the thoracic cavity, and above the pelvic cavity. It is a part of the abdominopelvic cavity. It is also known as coeliotomy.
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Terminology
In diagnostic laparotomy (most often referred to as an exploratory laparotomy and abbreviated Ex-Lap), the nature of the disease is unknown, and laparotomy is deemed the best way to identify the cause.
In therapeutic laparotomy, a cause has been identified (e.g. peptic ulcer A peptic ulcer, also known as ulcus pepticum, PUD or peptic ulcer disease, is an ulcer of an area of the gastrointestinal tract that is usually acidic and thus extremely painful. As many as 80% of ulcers are associated with Helicobacter pylori, a spiral-shaped bacterium that lives in the acidic environment of the stomach, however only 40% of those, colon cancer Colorectal cancer, also called colon cancer or large bowel cancer, includes cancerous growths in the colon, rectum and appendix. With 655,000 deaths worldwide per year, it is the fourth most common form of cancer in the United States and the third leading cause of cancer-related death in the Western world. Colorectal cancers arise from adenomatous) and laparotomy is required for its therapy.
Usually, only exploratory laparotomy is considered a stand-alone surgical operation. When a specific operation is already planned, laparotomy is considered merely the first step of the procedure.
Spaces accessed
Depending on incision placement, laparotomy may give access to any abdominal organ or space, and is the first step in any major diagnostic or therapeutic surgical procedure of these organs, which include:
- the lower part of the digestive tract The Human gastrointestinal tract is the system by which ingested food is acted upon by physical and chemical means to provide the body with nutrients it can absorb and to excrete waste products; in mammals the system includes the alimentary canal extending from the mouth to the anus, and the hormones and enzymes assisting in digestion (the stomach In some animals, including vertebrates, echinoderms, insects and molluscs, the stomach is a muscular, hollow, dilated part of the alimentary canal which functions as the primary organ of the digestive tract. It is involved in the second phase of digestion, following mastication (chewing). The stomach is located between the esophagus and the small, duodenum The duodenum is the first section of the small intestine in most higher vertebrates, including mammals, reptiles, and birds. In fish, the divisions of the small intestine are not as clear and the terms anterior intestine or proximal intestine may be used instead of duodenum. In mammals the duodenum may be the principal site for iron absorption, jejunum The jejunum is the middle section of the small intestine in most higher vertebrates, including mammals, reptiles, and birds. In fish, the divisions of the small intestine are not as clear and the terms middle intestine or mid-gut may be used instead of jejunum, ileum The ileum is the final section of the small intestine in most higher vertebrates, including mammals, reptiles, and birds. In fish, the divisions of the small intestine are not as clear and the terms posterior intestine or distal intestine may be used instead of ileum and colon The colon is the last part of the digestive system in most vertebrates; it extracts water and salt from solid wastes before they are eliminated from the body, and is the site in which flora-aided fermentation of unabsorbed material occurs. Unlike the small intestine, the colon does not play a major role in absorption of foods and nutrients)
- the liver The liver is a vital organ present in vertebrates and some other animals. It has a wide range of functions, including detoxification, protein synthesis, and production of biochemicals necessary for digestion. The liver is necessary for survival; there is currently no way to compensate for the absence of liver function, pancreas The pancreas is a gland organ in the digestive and endocrine system of vertebrates. It is both an endocrine gland producing several important hormones, including insulin, glucagon, and somatostatin, as well as an exocrine gland, secreting pancreatic juice containing digestive enzymes that pass to the small intestine. These enzymes help to further and spleen The spleen is an organ found in virtually all vertebrate animals with important roles in regard to red blood cells and the immune system. In humans, it is located in the left upper quadrant of the abdomen. It removes old red blood cells and holds a reserve of blood in case of hemorrhagic shock while also recycling iron. It synthesizes antibodies
- the bladder In anatomy, the urinary bladder is the organ that collects urine excreted by the kidneys prior to disposal by urination. A hollow muscular, and distensible organ, the bladder sits on the pelvic floor. Urine enters the bladder via the ureters and exits via the urethra
- the female reproductive organs (the uterus The uterus (from Latin "uterus" , plural uteruses or uteri) or womb is a major female hormone-responsive reproductive sex organ of most mammals including humans. One end, the cervix, opens into the vagina, while the other is connected to one or both fallopian tubes, depending on the species. It is within the uterus that the fetus and ovaries The ovary is an ovum-producing reproductive organ, often found in pairs as part of the vertebrate female reproductive system. Ovaries in females are homologous to testes in males, in that they are both gonads and endocrine glands)
- the retroperitoneum The retroperitoneum is the anatomical space in the abdominal cavity behind (retro) the peritoneum. It has no specific delineating anatomical structures. Organs are retroperitoneal if they only have peritoneum on their anterior side (the kidneys The kidneys are paired organs with several functions. They are seen in many types of animals, including vertebrates and some invertebrates. They are an essential part of the urinary system and also serve homeostatic functions such as the regulation of electrolytes, maintenance of acid-base balance, and regulation of blood pressure. They serve the, the aorta The aorta is the largest artery in the body, originating from the left ventricle of the heart and extends down to the abdomen, where it branches off into two smaller arteries (the common iliacs). The aorta distributes oxygenated blood to all parts of the body through the systemic circulation, abdominal lymph nodes A lymph node is a small circular ball shape organ of the immune system, distributed widely throughout the body and linked by lymphatic vessels. Lymph nodes are garrisons of B, T, and other immune cells. Lymph nodes are found all through the body, and act as filters or traps for foreign particles. They contain white blood cells that use oxygen to)
- the appendix In human anatomy, the appendix (or vermiform appendix; also cecal appendix; also vermix) is a blind-ended tube connected to the cecum (or caecum), from which it develops embryologically. The cecum is a pouchlike structure of the colon. The appendix is located near the junction of the small intestine and the large intestine
Types of incisions
Midline
The most common incision for laparotomy is the midline incision, a vertical incision which follows the linea alba.
- The upper midline incision usually extends from the xiphoid process to the umbilicus The navel is a scar on the abdomen, caused when the umbilical cord is removed from a newborn baby. All placental mammals have a navel. It is fairly conspicuous in humans.
- A typical lower midline incision is limited by the umbilicus superiorly and by the pubic symphysis inferiorly.
- Sometimes a single incision extending from xiphoid process to pubic symphysis is employed, especially in trauma surgery Trauma surgery is a surgical specialty involved in the invasive treatment of physical injuries, typically in an emergency setting. Trauma surgeons generally complete residency training in general surgery and often fellowship training in trauma or surgical critical care. The trauma surgeon is responsible for the initial resuscitation and.
Midline incisions are particularly favoured in diagnostic laparotomy, as they allow wide access to most of the abdominal cavity.
Other
Other common laparotomy incisions include:
- the Kocher (right subcostal) incision (after Emil Theodor Kocher Emil Theodor Kocher was a Swiss physician, medical researcher, and Nobel laureate for his work in the physiology, pathology and surgery of the thyroid); appropriate for certain operations on the liver The liver is a vital organ present in vertebrates and some other animals. It has a wide range of functions, including detoxification, protein synthesis, and production of biochemicals necessary for digestion. The liver is necessary for survival; there is currently no way to compensate for the absence of liver function, gallbladder In vertebrates the gallbladder is a small organ that aids digestion and stores bile produced by the liver. In humans the loss of the gallbladder is usually easily tolerated and biliary tract;[1][2]
- the Davis or Rockey-Davis "muscle-splitting" right lower quadrant incision for appendectomy An appendectomy is the surgical removal of the vermiform appendix. This procedure is normally performed as an emergency procedure, when the patient is suffering from acute appendicitis. In the absence of surgical facilities, intravenous antibiotics are used to delay or avoid the onset of sepsis; it is now recognized that many cases will resolve;
- the Pfannenstiel incision, a transverse incision below the umbilicus and just above the pubic symphysis.[3][4] In the classic Pfannenstiel incision, the skin and subcutaneous tissue are incised transversally, but the linea alba is opened vertically. It is the incision of choice for Cesarean section A Caesarian section , also known as C-section or Caesar, is a surgical procedure in which incisions are made through a mother's abdomen (laparotomy) and uterus (hysterotomy) to deliver one or more babies. It is usually performed when a vaginal delivery would put the baby's or mother's life or health at risk, although in recent times it has been and for abdominal hysterectomy A hysterectomy is the surgical removal of the uterus, usually performed by a gynecologist. Hysterectomy may be total (removing the body, fundus, and cervix of the uterus; often called "complete") or partial (removal of the uterine body but leaving the cervical stump, also called "supracervical"). It is the most commonly for benign disease. A variation of this incision is the Maylard incision in which the rectus abdominis muscles Muscle is the contractile tissue of animals and is derived from the mesodermal layer of embryonic germ cells. Muscle cells contain contractile filaments that move past each other and change the size of the cell. They are classified as skeletal, cardiac, or smooth muscles. Their function is to produce force and cause motion. Muscles can cause are sectioned transversally to permit wider access to the pelvis.[5]
- Lumbotomy consists of a lumbar In tetrapod anatomy, lumbar is an adjective that means of or pertaining to the abdominal segment of the torso, between the diaphragm and the sacrum . The lumbar region is sometimes referred to as the lower spine. In human anatomy the five vertebrae in the lumbar region of the back are the largest and strongest in the movable part of the spinal incision which permits access to the kidneys The kidneys are paired organs with several functions. They are seen in many types of animals, including vertebrates and some invertebrates. They are an essential part of the urinary system and also serve homeostatic functions such as the regulation of electrolytes, maintenance of acid-base balance, and regulation of blood pressure. They serve the (which are retroperitoneal The retroperitoneum is the anatomical space in the abdominal cavity behind (retro) the peritoneum. It has no specific delineating anatomical structures. Organs are retroperitoneal if they only have peritoneum on their anterior side) without entering the peritoneal cavity The peritoneal cavity is a potential space between the parietal peritoneum and visceral peritoneum, that is, the two membranes that separate the organs in the abdominal cavity from the abdominal wall. It is one of the spaces derived from the coelomic cavity of the embryo, the others being the pleural cavities around the lungs and the pericardial. It is typically used only for benign renal lesions. It has also been proposed for surgery of the upper urological tract.[6]
Related procedures
A related procedure is laparoscopy Laparoscopy is an operation performed in the abdomen or pelvis through small incisions with the aid of a camera. It can either be used to inspect and diagnose a condition or to perform surgery, where cameras and other instruments are inserted into the peritoneal cavity The peritoneal cavity is a potential space between the parietal peritoneum and visceral peritoneum, that is, the two membranes that separate the organs in the abdominal cavity from the abdominal wall. It is one of the spaces derived from the coelomic cavity of the embryo, the others being the pleural cavities around the lungs and the pericardial via small holes in the abdomen. For example, an appendectomy An appendectomy is the surgical removal of the vermiform appendix. This procedure is normally performed as an emergency procedure, when the patient is suffering from acute appendicitis. In the absence of surgical facilities, intravenous antibiotics are used to delay or avoid the onset of sepsis; it is now recognized that many cases will resolve can be done either by a laparotomy or by a laparoscopic approach.
References
- ^ synd/1010 at Who Named It? Who Named It? is an English-language dictionary of medical eponyms and the people associated with their identification. Though this is a dictionary, many eponyms and persons are presented in extensive articles with comprehensive bibliographies. It is hosted in Norway and maintained by medical historian Ole Daniel Enersen
- ^ "Incisions". http://www.pdh-odp.co.uk/incisions.htm. Retrieved 2007-11-22.
- ^ synd/2500 at Who Named It? Who Named It? is an English-language dictionary of medical eponyms and the people associated with their identification. Though this is a dictionary, many eponyms and persons are presented in extensive articles with comprehensive bibliographies. It is hosted in Norway and maintained by medical historian Ole Daniel Enersen
- ^ H. J. Pfannenstiel. Ueber die Vortheile des suprasymphysären Fascienquerschnitts für die gynäkologischen Koeliotomien. (Volkmann’s) Sammlung klinischer Vorträge, Leipzig, 1900, n F. 268 (Gynäk. Nr. 97), 1735-1756.
- ^ Giacalone PL, Daures JP, Vignal J, Herisson C, Hedon B, Laffargue F (2002). "Pfannenstiel versus Maylard incision for cesarean delivery: A randomized controlled trial". Obstetrics and gynecology 99 (5 Pt 1): 745–50. doi A digital object identifier is a character string used to uniquely identify an electronic document or other object. Metadata about the object is stored in association with the DOI name and this metadata may include a location, such as a URL, where the object can be found. The DOI for a document is permanent, whereas its location and other metadata:10.1016/S0029-7844(02)01957-9. PMID A PMID is a unique number assigned to each PubMed citation of life sciences and biomedical scientific journal articles. The related Pubmed Central archive may additionally assign a separate number, a PMCID (PubMed Central Identifier), normally written with a PMC prefix 11978282.
- ^ Bajpai M, Kumar A, Gupta AK, Pawar DK (2004). "Lumbotomy approach for upper urological tract surgery in children--an analysis of 68 consecutive lumbotomies". European journal of pediatric surgery : official journal of Austrian Association of Pediatric Surgery ... [et al.] = Zeitschrift für Kinderchirurgie 14 (3): 163–7. doi A digital object identifier is a character string used to uniquely identify an electronic document or other object. Metadata about the object is stored in association with the DOI name and this metadata may include a location, such as a URL, where the object can be found. The DOI for a document is permanent, whereas its location and other metadata:10.1055/s-2004-820903. PMID A PMID is a unique number assigned to each PubMed citation of life sciences and biomedical scientific journal articles. The related Pubmed Central archive may additionally assign a separate number, a PMCID (PubMed Central Identifier), normally written with a PMC prefix 15211405.
External links
Categories: Surgery
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