To fully inspect the duodenum and the pancreas and to access deeper structures behind themĪorta, inferior vena cava, posterior duodenum, posterior pancreasīased on where and what injury or disease is identified, one or more additional procedures may be performed during an exploratory laparotomy, including: Emil Theodor Kocher in which the duodenum and the head of the pancreas are mobilized and moved out of the way to the left Inferior vena cava, portal vein, right iliac vessels, right renal vessels To provide access to deeper retroperitoneal right-sided abdominal structuresĭuodenum, pancreatic head, right hemicolon John Braasch in which right-sided abdominal organs are mobilized and moved temporarily out of the way Stomach, pancreatic tail, spleen, left kidney, left hemicolonĪorta, left iliac vessels, left renal vessels, pelvic vesselsĬattell-Braasch maneuver ("right medial visceral rotation") To provide access to deeper retroperitoneal left-sided abdominal structures Kenneth Mattox in which left-sided abdominal organs are mobilized and moved temporarily out of the way Mattox maneuver ("left medial visceral rotation") If necessary, several other surgical maneuvers or procedures may be performed. If being performed for cancer staging, special attention will be paid during the exploratory laparotomy to the lymph nodes, which may be biopsied, or removed and assessed with a microscope or other special tests to see whether they contain cancerous cells indicative of cancer spread. The surfaces of the spleen and the liver also are examined for injury. The gastrocolic ligament is incised and the lesser sac is explored, including the posterior stomach and the anterior pancreas.
The small bowel is "run", or looked at segment by segment, along its entire length from the ligament of Treitz to the terminal ileum. Ī systematic approach is taken to examining the abdominal organs for disease. This allows the surgeon to focus on one area at a time by removing the sponges from that quadrant. In these cases, sponges are often packed in the spaces around the liver and the spleen to slow bleeding until a source can be found. In trauma exploratory laparotomy, any immediate, life-threatening bleeding is first identified and controlled. The surgeon then looks for evidence of injury, infection, or disease. After opening the fascia, the abdominal cavity, or peritoneum, is entered. The fibrous tissue of the linea alba, which separates the right and the left abdominal muscles, serves as a guide for where to cut. This midline incision extends from the xiphoid process at the bottom of the chest to the pubic symphysis at the bottom of the pelvis. Scar from midline incision for exploratory laparotomyĪ vertical cut, or incision, is made in the middle of the abdomen. Inability to access the part of the abdomen where a surgical disease is using a less invasive approach, or a lack of laparoscopic equipment, technology, or training.Cancer staging, especially ovarian cancer and Hodgkin and non-Hodgkin lymphoma.Acute abdomen with evidence of inflammation of the abdominal lining or the abdominal organs, gastrointestinal bleeding, or gastrointestinal perforation.Acute blunt or penetrating trauma with evidence of internal bleeding (a positive focused assessment with sonography for trauma, diagnostic peritoneal lavage, or CT scan), unstable blood pressure, or evisceration.Reasons why a patient may require an exploratory laparotomy include: A database that tracks exploratory laparotomies performed in the United Kingdom estimates that about 30,000 are done across England and Wales each year out of a population of 59.5 million people. With the development of less invasive laparoscopic surgical techniques, exploratory laparotomies are less common than they used to be. Recovery typically involves a prolonged hospital stay, sometimes in the intensive care unit, and may include rehabilitation with one or more therapies. Overall operative mortality ranges between 10% and 20% worldwide for emergent exploratory laparotomies. Various other maneuvers, such as the Kocher maneuver, or other procedures may be performed concurrently. ĭuring an exploratory laparotomy, a large incision is made vertically in the middle of the abdomen to access the peritoneal cavity, then each of the quadrants of the abdomen is examined. It is also used in certain diagnostic situations, in which the operation is undertaken in search of a unifying cause for multiple signs and symptoms of disease, and in the staging of some cancers. It is the standard of care in various blunt and penetrating trauma situations in which there may be life-threatening internal injuries. An exploratory laparotomy is a general surgical operation where the abdomen is opened and the abdominal organs are examined for injury or disease.
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