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Exploratory laparotomy
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Exploratory laparotomy

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  • 1. Exploratory Laparotomy Dr Imran Javed. Associate Professor Surgery. Fiji National University.
  • 2. Indications • Acute Abdomen due to: • 1-Trauma (Blunt & Penetrating). • 2- Infections (Acute & Chronic). • 3- Malignancy ( Treatment, Diagnosis & dealing with Complications). • 4- As a part of Gynecological or Urological Procedures. • 5- Complicated Laparoscopic or Endoscopic Procedure. • 6- Removal of Foreign Bodies like dislodged copper T.
  • 3. Position. • The patient is placed in the supine position, with the arms abducted at right angles to the body. • The lithotomy position may be employed instead when a pelvic pathology is suspected and a simultaneous vaginal or rectal intervention is necessary.
  • 4. Preop Prepration • 4 Tube Principle: • 1- Intravenous Line • 2- Urinary Catheter. • 3- Endotracheal tube. • 4- CVP line in intensive monitoring. • Preop Antibiotics. • Arrangement of blood & Blood products.
  • 5. Anesthesia. • Exploratory laparotomy is performed with the patient under general anesthesia. • Patients who are anesthetized for emergency surgery are at higher risk for aspiration of gastric contents. Adequate care must be taken to empty the stomach before induction.
  • 6. Upper midline incision. Incision is deepened through subcutaneous tissue to expose linea alba.
  • 7. Linea alba is divided to reveal pre- peritoneal fat.
  • 8. Abdominal incision is completed to reveal intra-abdominal organs.
  • 9. Laparotomy in patient with peritonitis. Image shows perforated duodenal ulcer.
  • 10. Laparotomy in patient with intestinal obstruction
  • 11. Sigmoid volvulus with gangrene.
  • 12. Multiple omental deposits in patient with disseminated carcinoma of stomach.
  • 13. Multiple metastatic deposits over small bowel in patient with colonic malignancy
  • 14. Liver laceration in traffic accident victim who presented with hemoperitoneum
  • 15. Drains after an exploratory laparotomy • Patients with extensive contamination may benefit from drains in the subhepatic space and the pelvis. • Suction Drains may be needed for prevention of blood collections in the peritoneal cavity. • Gravity Drains are placed for most of the routine procedures. • Sump Drainage in cases of necrotizing Pancreatitis.
  • 16. Single-layer mass closure • Closure is carried out with either nonabsorbable suture material (eg, polypropylene) or a delayed absorbable suture material (eg, polydioxanone) in either a continuous suture or interrupted sutures. The standard approach is to place sutures about 1 cm from the edge of the incised linea alba, maintaining a distance of 1 cm between successive bites.
  • 17. Complications of Procedure • Immediate complications: • Paralytic ileus • Intra-abdominal collection or abscess • Wound infections • Abdominal wall dehiscence • Pulmonary atelectasis • Enterocutaneous fistula • Delayed complications : • Adhesive intestinal obstruction • Incisional hernia