Intervention: Laparotomy
Abdominal cavity
ICD-10 code:
ICD-9 code:	54.1
Other codes:

A laparotomy is a surgical procedure involving an incision through the abdominal wall to gain access into the abdominal cavity. It is also known as coeliotomy.

Contents 1 Terminology 2 Spaces accessed 3 Types of incisions 3.1 Midline 3.2 Other 4 Related procedures 5 References 6 External links

[edit] 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, colon cancer) 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.

[edit] Spaces accessed

Depending on incision placement, it 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 stomach, duodenum, jejunum, ileum and colon)
• the liver, pancreas and spleen
• the bladder
• the female reproductive organs (the uterus and ovaries)
• the retroperitoneum (the kidneys, the aorta, abdominal lymph nodes
• the appendix

[edit] Types of incisions

[edit] 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.

• 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.

Midline incisions are particularly favoured in diagnostic laparotomy, as they allow wide access to most of the abdominal cavity.

[edit] Other

Other common laparotomy incisions include:

• the Kocher (right subcostal) incision (after Emil Theodor Kocher); appropriate for certain operations on the liver, gallbladder and biliary tract;^[1][2]

• the Davis or Rockey-Davis "muscle-splitting" right lower quadrant incision for appendectomy;

• 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 and for abdominal hysterectomy for benign disease. A variation of this incision is the Maylard incision in which the rectus abdominis muscles are sectioned transversally to permit wider access to the pelvis.^[5]

• Lumbotomy consists of a lumbar incision which permits access to the kidneys (which are retroperitoneal) without entering the peritoneal cavity. It is typically used only for benign renal lesions. It has also been proposed for surgery of the upper urological tract.^[6]

[edit] Related procedures

A related procedure is laparoscopy, where cameras and other instruments are inserted into the peritoneal cavity via small holes in the abdomen. For example, an appendectomy can be done either by a laparotomy or by a laparoscopic approach.

[edit] References

[edit] External links

• Laparotomy Video
• Article about Laparotomy exploratory
• Article about Abdominal exploratory surgery in animals

v • d • e Digestive system surgical and other procedures (ICD-9-CM V3 42-54) Digestive tract Upper GI tract SGs/Esophagus Sialography · Esophagectomy Stomach Gastrostomy (Percutaneous endoscopic gastrostomy) · Gastrectomy (Billroth I, Billroth II, Roux-en-Y) · Bariatric surgery (Gastric bypass surgery, Adjustable gastric band, Sleeve gastrectomy, Vertical banded gastroplasty surgery) · Gastroenterostomy · Hill repair · Nissen fundoplication · Gastropexy Imaging Endoscopy: Esophagogastroduodenoscopy Upper gastrointestinal series Lower GI tract Small bowel Bariatric surgery (Duodenal switch, Jejunoileal bypass) · Jejunostomy · Ileostomy · Partial ileal bypass surgery Large bowel Colectomy · Colostomy · Appendicectomy · Hartmann's operation Rectum Lower anterior resection · Abdominoperineal resection Anus Anal sphincterotomy · Lateral internal sphincterotomy Imaging Endoscopy: Colonoscopy (Virtual) · Proctoscopy · Sigmoidoscopy · Enteroscopy · Capsule endoscopy Transrectal ultrasonography · Enteroclysis · Small bowel follow-through · Abdominal ultrasonography · Lower gastrointestinal series Accessory Liver Hepatectomy · Liver transplantation · Artificial extracorporeal liver support (Liver dialysis, Bioartificial liver devices) Gallbladder, bile duct Cholangiography (Endoscopic retrograde cholangiopancreatography, Percutaneous transhepatic cholangiography, Magnetic resonance cholangiopancreatography) · Cholecystectomy · Cholecystography · HIDA scan Pancreas Pancreatectomy · Pancreaticoduodenectomy · Pancreas transplantation · Puestow procedure · Frey's procedure Abdominopelvic Peritoneum Paracentesis · Intraperitoneal injection Hernia Herniorrhaphy · MacEwen's operation Other Laparotomy digestive system navs: anat of tract,glands,perit,diaphragm/physio/dev, noncongen/congen/congen of d+w/neoplasia, symptoms+signs/eponymous, proc