Laparotomy

For Laparotomy or celiotomy means a surgical incision of the anterior abdominal wall that allows access to the abdominal cavity and the organs contained in it .

 

On the basis of this division topographical would seem that each organ can be attacked in an appropriate manner with a laparotomy that falls in a specific sector . This is true but for certain diseases and for certain actions . In reality, the criteria used to guide the choice of the type of incision are broader :

•  Simplicity and speed of execution . Demand especially in the interventions provided in an emergency or when they have to be completed quickly.
•     Optimal exposure of the organ but also of the entire abdominal cavity. An essential requirement in traumatic pathology , in ' acute abdomen , in neoplastic diseases , in cases of diagnostic doubt .
•     Possibility of having to expand the cut during surgery . Occurrence related to intraoperative complications , the detection of anatomical abnormalities or position induced by the underlying disease .
•     Compared with the vascular and nerve structures and lines of Langer .
•     Simplicity and appropriateness of the immediate reconstruction to avoid complications such as infection and wound dehiscence , incisional hernia and later as to minimize the post-operative pain .
•     Habits and experience of the surgeon.
•     In reality there is a laparotomy ideal but a series of etchings that each have advantages and limitations.

 

The timing of laparotomy are:

Opening

The initial incision includes skin and subcutaneous tissue .

The plan is opened by cutting the muscle fascia with a scalpel cold and muscle with the electric scalpel that reduces bleeding by coagulating vessels . Typically the cut follows the course of the fibers in the transverse incisions except where they are cut . In some actions you can avoid the section of muscle merely to spread the fibers .

The peritoneum is opened after making sure that there are no loops or adhering closely with its inner surface .

 

Closure

Consists of the time in which the end of the intervention proceeds all'affrontamento respecting the layers of the walls and after careful control of potential bleeding points . It starts from the peritoneum which is usually closed with a continuous suture absorbable hemostatic material paying particular attention to not understand the point that even the intestines in some diseases , such as intestinal ileus mechanical , it can be difficult to make much dilated the closure of the wall. The muscle is combined with points not very tight to prevent the trancino . If the fibers have been cut, as happens in the transverse laparotomy , are sutured end to end . Particularly important is the closure of the wing that is sutured with sutures and non-absorbable suture material . To the skin and the subcutaneous wire you can use a non-absorbable nature like silk, artificial monofilament or even a series of staples. When possible, you can use the technique of intradermal points .

 

Placement of drainage endoabdominal

After some interventions may be necessary to let light into the abdomen drains or sewer taking care to make them go outside at a point distant from the laparotomy incision .

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