Median laparotomy is a rather complicated operation, requiring a specialist to have in-depth knowledge of anatomy, as well as skills in using surgical instruments. In addition, this procedure requires some preparation of the patient.
What is a procedure like?
Median laparotomy, a photo of which clearly demonstrates the peculiarity of the operation, is a surgical procedure performed through an incision on the anterior wall of the abdominal cavity. The method of incision largely depends on the volume of surgical intervention and the area where the operation will be performed.
In addition, with the help of this operation, it is possible to carry out diagnostics in order to identify pathologies that cannot be detected in another way.
Features of the operation
Median laparotomy should be performed subject to certain principles of the intervention:
- with a minimum level of trauma;
- without touching large blood vessels;
- bypassing nerve endings.
At the end of the required manipulations, the tissues must be sewn in such a way that the seam does not open, the internal organs are not deformed. The operation is performed in the presence of various injuries and oncological diseases.
Types of Laparotomy
In surgical practice, a variety of types of operations are used, namely:
- median laparotomy;
- lower middle laparotomy;
- lower laparotomy.
Often the median operation is used. In this case, the incision is performed along the midline of the abdomen.
Diagnostic Laparotomy
Diagnostic laparotomy is rarely used, mainly for injuries of the abdominal organs, acute surgical diseases that cannot be detected with other research methods. Basically, this diagnostic method is used:
- in the presence of an injury to the stomach, pancreas, kidneys;
- peptic ulcer disease;
- malignant tumors;
- necrosis;
- internal hernia;
- peritonitis.
This operation requires complex preliminary preparation, during which specialists pre-determine the progress of the work, assess the existing risks and take measures to eliminate them. The duration of the procedure is no more than 2 hours, and with severe bleeding no more than 20-30 minutes.
Indications for surgery
The main indications for a median laparotomy are as follows:
- rupture of an ovarian cyst;
- tubal infertility;
- ectopic pregnancy;
- ovarian cyst;
- purulent inflammation of the fallopian tubes or ovary;
- inflammation of the peritoneum.
In addition, various kinds of tumors of the internal reproductive organs can be a problem.
Rules for
Surgical manipulations have many varieties, depending on the disease, which is an indication for the operation, the anatomical features of the patient, as well as many other factors. There are such methods:
- longitudinal;
- oblique;
- transverse;
- angular;
- mixed.
Regardless of the type of incision, a number of rules must be observed during the operation. It is important that the patient is correctly positioned on the couch. For example, when conducting a median laparotomy, the patient should lie on his back. During the upper-middle operation, a roller should be located under the lower back to slightly raise the operated area. It is important to avoid trauma to nerve fibers.
To prevent infection of the incision, as well as severe bleeding, the edges must be covered with sterile wipes and tampons. To prevent the formation of adhesions, saline should be used. After performing glancing, the surgeon assesses the degree of the pathological process and its spread, eliminates bleeding and examines the lymph nodes.
Preparation for the procedure
Preparation for the operation has almost no features. The patient takes a blood sample for analysis:
- general;
- biochemical;
- for sugar.
In addition, you need to determine the blood group and Rh factor, take blood and urine tests to determine various infections. Depending on the reason for the operation, you must initially do an ultrasound of the diseased organ. In connection with the anatomical features of the pathological process, a technique for performing laparotomy is selected.
The day before the operation, you can not eat and drink plenty of fluids. Depending on the blood type and the characteristics of the course of the disease, the resuscitator selects the type of anesthesia. If the disease has acquired an acute form and emergency intervention is required, then the preparation is minimized to two hours.
Operation Technique
The technique of median laparotomy refers to the longitudinal. It can be lower, upper or middle. The lower median laparotomy is not performed very often, only in cases where extensive access to the diseased organ is required, and also as a result of:
- motionless tumor;
- revisions of the abdominal cavity;
- extended uterine intervention.
The incision is performed in the lower abdomen, vertically in the middle, and allows access to the internal genitalia and other organs located in this area. If necessary, the incision can be additionally carried up, bypassing the liver and the navel. The lower laparotomy is performed with a pen scalpel in the direction from bottom to top. The incision is performed in layers so as not to injure the intestines and many other internal organs. The length of the incision is determined according to the proposed surgical intervention, but it should not be too large or small. The edges of the section are moved apart by special clamps, then the operation is performed. When performing a lower middle laparotomy, the incision can be not only vertical, but also transverse, for example, with a caesarean section. In this case, an incision is made in the lower abdomen, cutting it across, above the pubic bone. During surgery, the vessels are cauterized by coagulation. Transverse laparotomy has a much shorter postoperative period than the longitudinal one, since it is less traumatic for the intestine and the suture will be less noticeable.
The upper median laparotomy is characterized by the fact that a vertical incision is made in the middle of the abdomen, only it begins in the intercostal space and stretches down, but does not reach the navel. This type of operation has a number of advantages, as it provides the most rapid penetration to the abdominal organs located in its upper part. This is important if the slightest delay will cost the patient life, as well as with extensive internal bleeding or damage to several organs at once. If necessary, the incision can be extended down.
Median median laparotomy has certain disadvantages. For example, using this technique, the upper and lower sections of muscle tissue can be very injured. When scarring, muscle fibers experience very strong tension, which threatens to form a hernia. In addition, the tissues heal for a very long time due to the significant depth of the seam and poor blood supply to this area.
Operation stages
Initially, the skin is cut along with the subcutaneous tissue. After completing the incision, the wound must be drained and seized with special clamps bleeding vessels. Using wipes, the surgeon isolates the surgical wound from the skin.
After that, the doctor performs a dissection of the peritoneum with special scissors. The edges of the abdominal cavity are divorced, and internal organs are examined to determine and eliminate pathological processes. After the operation, drainage is established, which is fixed to the skin with a silk thread. The seam is applied initially to the peritoneum, and then the skin is sutured. After laparotomy, the stomach is carefully treated with an antiseptic.
Postoperative period
After median laparotomy, the patient should be under the supervision of doctors in a hospital for at least a week. Since this operation is abdominal and rather complicated, it is important to prevent the risk of complications, in particular:
- internal bleeding;
- wound infection;
- violation of the functioning of internal organs.
In the first days after the operation, patients may experience severe pain, therefore, analgesics in the form of injections are used. With an increase in temperature, antibiotics can be prescribed.
Sutures are usually removed on the seventh day, but with slow healing or in the case of repeated surgery, this period can be extended to two weeks. After discharge from the hospital, rehabilitation is carried out on an outpatient basis, but it is necessary to undergo regular examinations. Sport after median laparotomy is contraindicated for several months. It is especially not recommended to do loads on the abdominal muscles and lift weights.
In the process of rehabilitation, you should adhere to a healthy diet, do not overeat, as the operation can adversely affect the functioning of the intestine. The doctor determines all other contraindications individually for each patient, depending on the initial disease.
Contraindications and complications
Laparotomy, which is performed urgently, has absolutely no contraindications. Scheduled operations necessarily require preliminary treatment of inflammatory processes, which can provoke a variety of complications in the postoperative period.
Laparotomy can be complicated by a variety of pathological conditions, namely:
- bleeding in the area of the operation;
- suppuration of the wound;
- vascular damage;
- damage to adjacent organs;
- the formation of adhesions.
Since there are certain contraindications for the operation, alternative methods of treatment can be selected.