Exploratory Laparotomy

Exploratory laparotomy is surgery to open up the belly area (abdomen). This surgery is done to find the cause of problems (such as belly pain or bleeding) that testing could not diagnose. It is also used when an abdominal injury needs emergency medical care. This surgery uses one large cut (incision). The provider can then see and check the organs inside the abdomen. If the cause of the problem is found during the procedure, then treatment is often done at the same time. In some cases, a minimally invasive surgery called exploratory laparoscopy may be used instead. That method uses a tiny camera and several small incisions. But in many cases an exploratory laparotomy is preferred. Read on to learn more about this procedure.

Reasons for the surgery

Organs that may be looked at during exploratory laparotomy include:

• Liver

• Gallbladder

• Spleen

• Pancreas

• Kidneys

• Stomach

• Small intestine (small bowel)

• Large intestine (colon or large bowel)

• Appendix

• Ovaries, fallopian tubes, and uterus (in women)

• Lymph nodes 

• Abdominal blood vessels 

• Membranes that line the abdominal cavity

Getting ready for the surgery

The surgery takes place in a hospital. It is done by a surgeon. You will likely stay in the hospital for a few days or longer. To prepare for the surgery, do the following:

• Tell your provider about any medicines you’re taking. This includes over-the-counter medicines, prescription medicines, herbs, street drugs, herbs, vitamins, and other supplements. You may need to stop taking some or all of them for a time before the surgery.

• Tell your provider if you drink alcohol. This is very important if you are a heavy drinker. Alcohol withdrawal can be life-threatening, so be honest with your provider.

• Also tell your provider if you have any allergies or other health problems. This includes recent illnesses, especially any bleeding problems.

• Follow any directions you are given for not eating or drinking before surgery.

The day of the surgery

• Most exploratory laparotomies are done as emergency surgery after an injury or accident. 

• You will be checked for risks of heart, lung, or other problems during surgery. 

• You may need to change into a hospital gown.

• Before the surgery begins, an IV (intravenous) line is put into a vein in your arm or hand. This line supplies fluids and medicines.

• You will be given medicine (general anesthesia) to keep you free of pain. This medicine puts you in a state like deep sleep during the surgery. 

• A tube may be placed through your mouth and into your throat to help with breathing. Also, monitors are attached to your body. These record your vital signs, such as heart rate and blood pressure, during the surgery. 

• A thin tube (catheter) is placed into your bladder. This tube drains urine from your bladder during the surgery.

During the surgery

• The skin over your belly is cleaned.

• An incision is made in your belly.

• The tissue, blood vessels, and organs in your belly are carefully looked at and checked for problems.

• Tissue samples (biopsy) may be removed and sent to a lab for study.

• If the cause of the problem is found, treatment may be done then, if needed.

• When the surgery is done, the incision is closed with stitches (sutures) or staples. A drain may be placed in the abdomen to remove any extra fluids.

After the surgery

• You will be taken to a room to rest until you have recovered from the anesthesia. Nurses will closely watch your condition. When you are more awake and alert, you will be moved to another room.

• Medicines are given to help prevent infection and to manage pain, if needed.

• You will not be given food or drink until your bowels start to work normally again. This may take a few days.

• You will need to get up and walk around as soon as you are able. This helps to prevent blood clots.

• Also, you may be given breathing exercises to do. These help prevent pneumonia.

• The tube to drain urine is usually removed within a few days.

• If a drain was used for your incision, this is also removed.

• You will be able to go home when the provider says there are no issues of concern.

• Arrange for an adult family member or friend to drive you home.

• Before leaving, make sure you have all the prescriptions and home care instructions you will need. Also make sure you have a contact number for your provider or the hospital. This is in case you have problems or questions after the surgery.

• Do not lift anything heavier than 5 pounds for about 6 weeks. This gives tissue time to heal, and can prevent a hernia.

Follow-up

Recovery time will vary for each person. It may take as long as 4 to 6 weeks. You will need to see your provider for follow-up. This is to remove any sutures or staples and to check your healing progress.