ICD-9-CM 54.1 MeSH
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.
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 lower part of the digestive tract (the stomach, duodenum, jejunum, ileum and colon)
- the liver, pancreas, gallbladder, and spleen
- the bladder
- the female reproductive organs (the uterus and ovaries)
- the retroperitoneum (the kidneys, the aorta, abdominal lymph nodes)
- the appendix
Types of incisions
The most common incision for laparotomy is the midline incision, a vertical incision which follows the linea alba.
- 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.
Other common laparotomy incisions include:
- the Kocher (right subcostal) incision (after Emil Theodor Kocher); appropriate for certain operations on the liver, gallbladder and biliary tract. This shares a name with the Kocher incision used for thyroid surgery: a transverse, slightly curved incision about 2 cm above the sternoclavicular joints;
- the Davis or Rockey-Davis "muscle-splitting" right lower quadrant incision for appendectomy;
- the Pfannenstiel incision, a transverse incision below the umbilicus and just above the pubic symphysis. 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.
- 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.
- Cherney Incision
A related procedure is laparoscopy, where cameras and other instruments are inserted into the peritoneal cavity via small holes in the abdomen. For example, an appendectomy can be done either by a laparotomy or by a laparoscopic approach.
- ^ synd/1010 at Who Named It?
- ^ "Incisions". Archived from the original on 2007-11-01. http://web.archive.org/web/20071101054358/http://www.pdh-odp.co.uk/incisions.htm. Retrieved 2007-11-22.
- ^ synd/2500 at Who Named It?
- ^ H. J. Pfannenstiel. Ueber die Vortheile des suprasymphysären Fascienquerschnitts für die gynäkologischen Koeliotomien. (Volkmann’s) Sammlung klinischer Vorträge, Leipzig, 1900, n F. 268 (Gynäk. Nr. 97), 1735-1756.
- ^ Giacalone PL, Daures JP, Vignal J, Herisson C, Hedon B, Laffargue F (2002). "Pfannenstiel versus Maylard incision for cesarean delivery: A randomized controlled trial". Obstetrics and gynecology 99 (5 Pt 1): 745–50. doi:10.1016/S0029-7844(02)01957-9. PMID 11978282.
- ^ Bajpai M, Kumar A, Gupta AK, Pawar DK (2004). "Lumbotomy approach for upper urological tract surgery in children--an analysis of 68 consecutive lumbotomies". European Journal of Pediatric Surgery 14 (3): 163–7. doi:10.1055/s-2004-820903. PMID 15211405.
Digestive system surgical and other procedures / Digestive system surgery (ICD-9-CM V3 42-54, ICD-10-PCS 0D) Digestive tractUpper GI tractTransrectal ultrasonography · Abdominal ultrasonography · Enteroclysis · Small bowel follow-through · Lower gastrointestinal series · Virtual colonoscopy · Defecating proctogram · Double-contrast barium enema Accessory AbdominopelvicHernia repair: Inguinal hernia repair (Macewen's operation) · Femoral hernia repair Other CPRs
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Laparotomy — Lap a*rot o*my, n. [Gr. ? loins + te mnein to cut.] (Surg.) A cutting through the walls of the abdomen, as in the C[ae]sarean section. [1913 Webster] … The Collaborative International Dictionary of English
laparotomy — [lap΄ə rät′ə mē] n. pl. laparotomies [ LAPARO + TOMY] a surgical incision into the abdomen … English World dictionary
Laparotomy — An operation to open the abdomen. The word laparotomy was first used to designate this operation in 1878 by an English surgeon, Thomas Bryant. The word has an interesting derivation. It was compounded from Greek roots lapara referring to the soft … Medical dictionary
laparotomy — UK [ˌlæpəˈrɒtəmɪ] / US [ˌlæpəˈrɑtəmɪ] noun [countable/uncountable] Word forms laparotomy : singular laparotomy plural laparotomies medical a cut that is made in the stomach in order to examine the inside of it … English dictionary
laparotomy — n. a surgical incision into the abdominal cavity. The operation is done to examine the abdominal organs as a help to diagnosis; for example, to establish the spread of a tumour (exploratory laparotomy) or as a prelude to major surgery, for… … The new mediacal dictionary
laparotomy — noun (plural mies) Date: 1878 surgical incision of the abdominal wall … New Collegiate Dictionary
laparotomy — /lap euh rot euh mee/, n., pl. laparotomies. Surg. 1. incision through the abdominal wall. 2. incision into the loin, esp. for access to the abdominal cavity. [1875 80; LAPARO + TOMY] * * * … Universalium
laparotomy — noun The surgical procedure for making an incision in the abdominal wall to gain access into the abdominal cavity. Performed either as exploratory surgery, or as the first step in an abdominal operation. Syn: coeliotomy … Wiktionary
laparotomy — Surgical incision into the abdominal wall … Bryson’s dictionary for writers and editors
laparotomy — n. small incision made in the wall of the stomach … English contemporary dictionary