Background
Location
An exploratory laparotomy is a large surgery allowing the surgeon full access to the abdomen and all the contents, including your stomach, small intestine, large intestine (colon), liver, spleen, pancreas, kidneys, gallbladder, large blood vessels, and other organs. This surgery is done under general anesthesia, so you will be asleep the entire time. The surgery involves an incision down the middle of the abdomen from under your rib cage, around the belly button, and down to the pubic bone (). This surgery could be offered as an emergency or as a planned procedure.
my is a large surgery allowing the surgeon full access to the abdomen and all the contents including your stomach, small intestine, large intestine (colon), liver, spleen, pancreas, kidneys, gallbladder, large blood vessels, and other organs. This surgery is done under general anesthesia so you will be asleep the entire time. The surgery involves an incision down the middle of the abdomen from under your rib cage, around the belly button and down to the pubic bone (figure 1. This surgery could be offered as an emergency or as a planned procedure.
Figure 1. Exploratory laparotomy incision (https://www.jaypeedigital.com/book/9789350251218/chapter/ch18).
What happens in the hospital?
This surgery could be offered as an emergency or as a planned procedure. In an emergency, this surgery is used to figure out why you may be bleeding (in a trauma situation) or in pain (if there is a hole in the intestines). Planned laparotomies may be due to a variety of diseases that the surgeon will discuss with you.
Medical (non-surgical) options
There is no medicine that can replace a laparotomy. You have likely already had multiple medications and imaging studies prior to the surgery. A CT scan allows the physician to examine the abdomen with the goal of figuring out what is causing the disease process.
Surgical options
Typically, if your surgeon is recommending an exploratory laparotomy, you have failed more conservative (non-operative) options. Conservative options may include a nasogastric tube (tube from the nose into the stomach) for a bowel obstruction, antibiotics for an infection, and blood if you are bleeding from a trauma. Sometimes the surgeon may offer an exploratory laparoscopy, which involves making a small incision (approximately 1 cm) and using a camera to examine the abdomen. In some cases, the surgeon may begin with a laparoscopy, but given the findings, must change to a laparotomy. If the surgeon changes to a laparotomy, this is to allow for the safest surgery possible.
Care after treatment
After an exploratory laparotomy, you may have a nasogastric tube or feeding tube depending on the reason for the surgery. You will likely not be able to eat right away; this is so your intestines can recover from the surgery. During the surgery, the surgeon has touched and moved your intestines. This, combined with anesthesia, can make the intestines slow down. Waiting until there is some bowel function (passing gas or having a bowel movement) ensures the intestines are moving and can tolerate food. Burping or belching after surgery means the intestines are not “awake” yet, and eating will increase the likelihood of becoming nauseous or starting to vomit. Once you are allowed to eat, the diet will begin with clear liquids and then increase to regular food as the surgeon sees fit.
You will have medication for pain control. During the surgery, the strength layer of the abdominal wall was cut and then put back together. This causes pain. The surgery team will have a variety of pain medications to help with different sources of pain. You will also have intravenous fluid in your intravenous line, and electrolytes will be replaced as needed to help you recover faster. You will be given a blood-thinning medication called heparin or enoxaparin to help prevent blood clots. This medication is injected into the skin multiple times a day.
You will be encouraged to move after surgery. This includes sitting on the end of the bed, walking, and sitting in a chair. Moving after surgery prevents complications, including pneumonia and ileus (slowing of the intestines).
Some of your existing medications will be held, and others will be started. This all depends on the type of medication you are on and what was done in the surgery. If you have diabetes, your blood glucose will be tested and insulin given if needed.
The incision will have a dressing to cover it. This will stay in place from 2 to 7 days depending on the type of dressing. Under the dressing, you will have staples (figure 2), sutures, glue, or the skin may be left open (figure 3). The type of dressing and skin closure changes depending on the surgeon’s preference and what had to be done in your abdomen during your surgery. You may also have a catheter in the bladder to drain urine. The nursing staff will empty the catheter and record this number for the care team to know. The catheter may be removed early after surgery or stay in again depending on what had to be done in the abdomen. You may also have a drain or multiple drains, which are plastic tubes coming out of your abdomen. These plastic tubes are used to drain fluid from the abdomen. The type of fluid being removed varies depending on the surgery you had, so ask the surgeon if the color and quantity are normal for the specific operation. Drains stay in place for a variety of times once again depending on the type of surgery.
Figure 2. Exploratory laparotomy incision closed with staples (https://www.shutterstock.com/image-photo/laparotomy-wound-closed-stapler-suture752629003).
Figure 3. Midline laparotomy incision with the skin left open (https://www.facs.org/for-medical-professionals/news-publications/journals/casereviews/issues/v3n3/11/).
Possible complications
Common complications following an exploratory laparotomy include surgical complications and postoperative complications. Surgical complications include the risk of the strength layer of the abdomen coming apart, which is called a fascial dehiscence or evisceration. Evisceration is the separation of the strength layer, followed by the intestines being visible to the naked eye. Both complications require a return to the operating room for repair. Postoperative complications include pneumonia from not taking deep breaths after surgery, urinary tract infections, ileus or slowing of the intestinal movement, and blood clots. Close attention to postoperative care and patient participation in mobility and deep breathing can help prevent these complications. Long-term complications of an exploratory laparotomy include hernias (outpouchings of the abdominal wall) and adhesions (scar tissue).
What happens next?
Discharge location
You could require discharge to skilled nursing care or inpatient rehabilitation depending on the reason you required the surgery. After surgery, you may work with a physical therapist and/or occupational therapist to assess how your mobility is affected by the surgery. Depending on your preop mobility, surgery, and recovery, the physical therapist may also recommend home physical therapy at discharge.
Wound care
It is ok to shower the second day after surgery. Let soap and water run over the incision but do not scrub the incision. Pat the incision dry with a towel. Keep the incision clean and dry; it is ok to cover it with a dry dressing if the incision rubs on your clothes. If you have staples, those should be removed in the office between days 10 and 14 after surgery.
Diet
It is ok to go back to your normal presurgery diet once cleared by the surgeon.
Activity
No lifting more than the weight of a gallon of milk for 1 month after surgery. This should help prevent weakness along the incision and can help prevent hernias. Walking and going up and down stairs are ok, and you should walk every day if able. Avoid activity that strains the abdominal muscles or creates more intra-abdominal pressure, such as heavy lifting or crunches, until cleared by the surgeon.
Funding Statement
The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.