terminology

1. 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.
Spaces accessed
Depending on incision placement, laparotomy 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 digestive tract (the stomach, duodenum, jejunum, ileum and colon)
 the liver, pancreas, gallbladder, and spleen
 the bladder
 the male prostate
 the female reproductive organs (the uterus and ovaries)
 the retroperitoneum (the kidneys, the aorta, abdominal lymph nodes)
 the appendix
Types of incisions
Main article: Surgical Incisions
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.

2. Midline incision
1. Cut (incised) the skin in mid line (linea alba)
2. Cut (incised) subcutaneous tissue
3. Divide the linea alba (white line of the abdomen)
4. Pick up peritoneum, confirm that there is no bowel adhesion (intestinal adhesion)
5. Nick peritoneum
6. Insert finger beneath the wound to make sure that there is no adhesion
7. Cut the peritoneum with scissors; operative surgery of (lsmu)
Other
Other common laparotomy incisions include:
 Kocher (right subcostal) incision (after Emil Theodor Kocher); appropriate for certain
operations on the liver, gallbladder and biliary tract.[1][2]
This shares a name with the
Kocher incision used for thyroid surgery: a transverse, slightly curved incision about
2 cm above the sternoclavicular joints;
 Davis or Rockey-Davis "muscle-splitting" right lower quadrant incision for
appendectomy;
 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]
 Cherney Incision