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Laparotomy
 
 
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A laparotomy is a surgical
Surgery

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, or sometimes for some other reason....
 procedure involving an incision through the abdominal wall to gain access into the abdominal cavity
Abdominal cavity

The abdominal cavity is the body cavity of the human body that holds the bulk of the viscus and which is located below the thoracic cavity, and above the pelvic cavity....
. It is also known as coeliotomy.

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.






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A laparotomy is a surgical
Surgery

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, or sometimes for some other reason....
 procedure involving an incision through the abdominal wall to gain access into the abdominal cavity
Abdominal cavity

The abdominal cavity is the body cavity of the human body that holds the bulk of the viscus and which is located below the thoracic cavity, and above the pelvic cavity....
. It is also known as coeliotomy.

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
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....
, colon cancer) and laparotomy is required for its therapy.

Usually, only exploratory laparotomy is referred to as a surgical operation by itself; and when a specific operation is already planned, laparotomy is considered merely the first step of the procedure.

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
    Stomach

    In most mammals, the stomach is a hollow muscular organ of the gastrointestinal tract involved in the second phase of digestion, following mastication....
    , duodenum
    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....
    , jejunum
    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
    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
    Colon (anatomy)

    The colon is the last portion of the digestive system in most vertebrates; it extracts water and salt from feces before they are defecation from the body....
    )
  • the liver
    Liver

    The liver is a vital organ present in vertebrates and some other animals; it has a wide range of functions, a few of which are detoxification, protein synthesis, and production of biochemicals necessary for digestion....
    , pancreas
    Pancreas

    The pancreas is a gland Organ in the digestive system and endocrine system of vertebrates. It is both an endocrine gland , as well as an exocrine gland, secreting pancreatic juice containing Digestion enzymes that pass to the small intestine....
     and spleen
    Spleen

    The spleen is an organ found in all vertebrate animals. In humans, the spleen is located in the abdomen of the body, where it functions in the destruction of redundant red blood cells, and holds a reservoir of blood....
  • the bladder
    Urinary bladder

    In anatomy, the urinary bladder is a solid, muscle, and distensible organ that sits on the pelvic floor in mammals. It is the organ that collects urine excreted by the kidneys prior to disposal by urination....
  • the female reproductive organs (the uterus
    Uterus

    The uterus is a major female hormone-responsive reproductive sex organ of most mammals, including humans. It is within the uterus that the fetus develops during gestation....
     and ovaries
    Ovary

    The ovary is an ovum-producing reproductive organ, often found in pairs as part of the vertebrate female reproductive system. Ovaries in females are homology to testicle in males, in that they are both gonads and endocrine glands....
    )
  • the retroperitoneum (the kidney
    Kidney

    The kidneys are Organ that have numerous biological roles. Their primary role is to maintain the homeostasis balance of bodily fluids by filtering and secreting Metabolomics#Metabolitess and minerals from the blood and excreting them, along with water , as urine....
    s, the aorta
    Aorta

    The aorta is the largest artery in the human body, originating from the left ventricle of the heart and bringing oxygenated blood to all parts of the body in the systemic circulation....
    , abdominal lymph node
    Lymph node

    A Lymph node is an organ consisting of many types of cells, and is a part of the lymphatic system. Lymph nodes are found all through the body, and act as filters or traps for foreign particles....
    s
  • the appendix
    Appendix

    Appendix, from the Latin word of the same name, may refer to an Index / Bibliography.* In book design, an appendix is a reference section at the end of a book ...


Types of incisions


Midline

The most common incision for laparotomy is the midline incision, a vertical incision which follows the linea alba
Linea alba

The linea alba is a fibrous structure that runs down the midline of the abdomen in humans and other vertebrates. The name means white line and the linea alba is indeed white, being composed mostly of collagen connective tissue....
.

  • The upper midline incision usually extends from the xiphoid process
    Xiphoid process

    The xiphoid Process , also known as the xiphisternum is a small Cartilage extension to the lower part of the sternum which is usually Ossification in the adult human....
     to the umbilicus
    Umbilicus

    Umbilicus may refer to:*Umbilicus , a feature of gastropod, Nautilus and Ammonite shell anatomy*Navel, a synonym for the navel or belly button....
    .


  • A typical lower midline incision is limited by the umbilicus
    Umbilicus

    Umbilicus may refer to:*Umbilicus , a feature of gastropod, Nautilus and Ammonite shell anatomy*Navel, a synonym for the navel or belly button....
     superiorly and by the pubic symphysis
    Pubic symphysis

    The pubic symphysis is the midline cartilage joint uniting the superior pubic ramus of the left and right pubis . It is located anterior to the urinary bladder and superior to the external genitalia; for females it is above the vulva and for males it is above the penis....
     inferiorly.


  • Sometimes a single incision extending from xiphoid process
    Xiphoid process

    The xiphoid Process , also known as the xiphisternum is a small Cartilage extension to the lower part of the sternum which is usually Ossification in the adult human....
     to pubic symphysis
    Pubic symphysis

    The pubic symphysis is the midline cartilage joint uniting the superior pubic ramus of the left and right pubis . It is located anterior to the urinary bladder and superior to the external genitalia; for females it is above the vulva and for males it is above the penis....
     is employed, especially in trauma surgery
    Trauma surgery

    Trauma surgeons are physicians Doctor of Medicine or Doctor of Osteopathic Medicine who have completed residency training in general surgery and fellowship training in trauma or surgical critical care....
    .


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

    Emil Theodor Kocher was a Swiss physician, medical researcher, and Nobel Prize in Physiology or Medicine for his work in the physiology, pathology and surgery of the thyroid....
    ); appropriate for certain operations on the liver
    Liver

    The liver is a vital organ present in vertebrates and some other animals; it has a wide range of functions, a few of which are detoxification, protein synthesis, and production of biochemicals necessary for digestion....
    , gallbladder
    Gallbladder

    The gallbladder is a small non-vital Organ which aids in the digestive process and concentrates bile produced in the liver....
     and biliary tract;


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


  • the Pfannenstiel incision
    Pfannenstiel incision

    A Pfannenstiel incision is a type of Surgery incision that allows access to the abdomen. The surgeon cuts on a generally horizontal line just above the pubic symphysis....
    , a transverse incision below the umbilicus
    Umbilicus

    Umbilicus may refer to:*Umbilicus , a feature of gastropod, Nautilus and Ammonite shell anatomy*Navel, a synonym for the navel or belly button....
     and just above the pubic symphysis
    Pubic symphysis

    The pubic symphysis is the midline cartilage joint uniting the superior pubic ramus of the left and right pubis . It is located anterior to the urinary bladder and superior to the external genitalia; for females it is above the vulva and for males it is above the penis....
    . In the classic Pfannenstiel incision, the skin and subcutaneous tissue are incised transversally, but the linea alba
    Linea alba

    The linea alba is a fibrous structure that runs down the midline of the abdomen in humans and other vertebrates. The name means white line and the linea alba is indeed white, being composed mostly of collagen connective tissue....
     is opened vertically. It is the incision of choice for Cesarean section and for abdominal hysterectomy
    Hysterectomy

    A hysterectomy is the surgery removal of the uterus, usually performed by a gynaecology. Hysterectomy may be total or partial . It is the most commonly performed gynecological surgical procedure....
     for benign disease. A variation of this incision is the Maylard incision in which the rectus abdominis muscle
    MUSCLE

    MUSCLE is public domain, multiple sequence alignment software for protein and nucleotide sequences.MUSCLE is integrated into UGENE bioinformatics tool as a plugin....
    s are sectioned transversally to permit wider access to the pelvis.


  • Lumbotomy consists of a lumbar
    Lumbar

    In anatomy, lumbar is an adjective that means of or pertaining to the abdominal segment of the torso, between the diaphragm and the sacrum ....
     incision which permits access to the kidney
    Kidney

    The kidneys are Organ that have numerous biological roles. Their primary role is to maintain the homeostasis balance of bodily fluids by filtering and secreting Metabolomics#Metabolitess and minerals from the blood and excreting them, along with water , as urine....
    s (which are retroperitoneal) without entering the peritoneal cavity
    Peritoneal cavity

    The peritoneal cavity is a potential space between the parietal peritoneum and visceral peritoneum. It is one of the spaces derived from the coelomic cavity of the embryo, the others being the pleural cavities and the pericardial cavity....
    . It is typically used only for benign renal lesions. It has also been proposed for surgery of the upper urological tract.


Related procedures

A related procedure is laparoscopy, where cameras and other instruments are inserted into the peritoneal cavity
Peritoneal cavity

The peritoneal cavity is a potential space between the parietal peritoneum and visceral peritoneum. It is one of the spaces derived from the coelomic cavity of the embryo, the others being the pleural cavities and the pericardial cavity....
 via small holes in the abdomen. For example, an appendectomy can be done either by a laparotomy or by a laparoscopic approach.

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