For laparotomy surgery. Is laparotomy a routine surgical operation or a dangerous procedure? How long does laparotomy take?

The operation to remove the uterus, or hysterectomy as it is also called, occupies one of the leading places in surgical gynecology.

Statistics say that a third of women who have crossed the age of forty-five years have had their uterus removed. Of course, when a woman first finds out that she needs a laparotomy, hysterectomy, or laparoscopic hysterectomy, a huge number of questions probably arise in her head, including what her life will be like in the future.

But are the consequences really that bad? Many patients who have undergone hysterectomy say that there are no categorical changes in appearance or in sexual life with a partner. However, much depends on the stage of the disease, the chosen method of surgery, the success of the operation and the recovery period.

Unfortunately, very often diseases in patients are diagnosed late, and doctors have to resort to extreme measures - hysterectomy, as the removal of the uterus along with the cervix is called (total hysterectomy). Indications for surgery are those diseases that are no longer amenable to drug treatment or that are rapidly progressing. These include oncological diseases (cervical cancer, uterine cancer, ovarian cancer), very large and numerous uterine fibroids (especially those that disrupt the functioning of neighboring organs), endometriosis, uterine fibrosis, uterine prolapse or prolapse, etc.

Total hysterectomy of the uterus in modern medicine is performed using two methods:

Laparotomy
Laparoscopy

These methods differ in surgical approaches, which depend on the stage of the disease, or the method is determined by the surgeon in relation to the individual characteristics of the body.

Laparotomy

Laparotomy (hysterectomy) is performed through an incision on the abdominal wall; in recent years, the incision has been used mainly along the Pfannenstiel route (under the bikini line). This is an operation that provides the surgeon with good access and visualization of all pelvic organs, which is necessary when performing oncological operations. It is worth noting that laparotomy and hysterectomy is a technically simple operation that does not require complex and expensive instruments, which is why it is so actively used by surgeons. However, this approach also has a huge number of disadvantages, including: bleeding during surgery, infection and injury to neighboring organs. In the postoperative period, complications after anesthesia are likely to occur, the formation of keloid scars, blood clots, inflammation of sutures, etc. The long and painful rehabilitation period after laparotomy and hysterectomy is perhaps the most important disadvantage.

Laparoscopic hysterectomy

Laparoscopic hysterectomy is a more modern method of performing the operation, requiring certain skills and experience, as well as expensive equipment, so this operation is not cheap. Surgical access is made through three or four small incisions and the insertion of special instruments and a camera into the incisions. Next, the surgeon performs all the necessary manipulations using the image from the camera displayed on the screen. This method is used not only for operations, but also as a research method. A pelvic ultrasound may not always be quite accurate, but a laparoscope makes it possible to examine in detail the structure (if it is abnormal) and the structure of the internal organs. Along with other methods, this is the most gentle operation due to the fact that the abdominal cavity does not open. The highest precision is achieved when the surgeon performs the necessary manipulations; it is minimally invasive and minimally traumatic with a short recovery period. Therefore, laparoscopic hysterectomy is the best choice for patients with indications for removal of the body and cervix.

Scientists have been actively studying the impact of uterine amputation surgery on a woman’s subsequent life for many years. Of course, the impact of surgery on each patient is different, but experts have identified several main factors.

Undoubtedly, in the first place are problems of a psycho-emotional nature (nervousness, depression, emotional disorders, anxiety, etc.). The fears that accompany a woman from the moment she learns that she is indicated for hysterectomy cannot but leave a mark on her mental state. After all, there are risks: how the operation will go, whether there will be complications after it, how her sex life will turn out and whether her family will be destroyed because of this, etc. In this case, complete and reliable information about the operation and future life will help. Of course, family and friends should provide constant emotional support, and a psychologist can explain what to do and how to behave in various situations, both to the patient and her family and friends.

Sex after hysterectomy will bring the woman the same sensations as before. This is due to the fact that all sensitive areas are located not in the uterus, but in the vagina and external genitalia. In a situation where a total hysterectomy was performed with removal of the appendages (ovaries and fallopian tubes), the gynecologist prescribes special hormone replacement therapy to prevent loss of sexual interest in the partner. This happens because the woman’s body stops producing sex hormones. Many patients claim that sexual intercourse after removal of the uterus has become even better, pain has stopped, and there is no need to think about contraception and the onset of an unwanted pregnancy. The absence of troubles associated with menstruation can also be considered a positive thing.

Concerns about changes in appearance are generally unfounded. Weight gain, loss of libido, increased facial hair growth, changes in voice timbre and other myths are fictitious. According to foreign studies, scientists have not found a single case of changes in appearance associated with removal of the uterus.

In young women, the consequences after removal of the uterus are the most severe. Loss of reproductive function, of course, cannot be a sign that she cannot become a mother. If the appendages were preserved when the uterus was removed, then surrogacy using IVF is a real solution to this problem. Removing the uterus before menopause increases the risk of a number of diseases (osteoporosis, vaginal prolapse, etc.). The most unpleasant thing is that, due to medical error, hysterectomy is performed on young women, depriving them of the joy of motherhood.

Our company invites women who have become victims of medical error to contact us and join the surrogacy program. Our lawyers will protect your interests in court and prove medical error, and then we will provide you with a surrogate mother. In order to participate in the program, you only need to fill out

In some cases, to treat the female organ, the doctor is forced to resort to a radical method. Laparotomy of the uterus is an operation in which there is open access to the organ. Before surgery, the doctor selects the most suitable type of transection, prepares the patient and sets the day on which it will occur.

Collapse

What is uterine laparotomy?

This surgical procedure is a technique in which an incision is made in the abdomen, through which the surgeon can directly access the organ. Thus, it is possible to accurately diagnose the pathology and eliminate its cause. Used for serious pathologies in the peritoneal area. Popular in gynecology.

In what cases is surgery performed?

Laparotomy is done if a woman:

there are cysts on the ovaries, after cisectomy;
hysterectomy is planned;
myomatous nodes are removed during myectomy;
perform a caesarean section;
pregnancy outside the uterus.

All of the above are indications for this method of surgical intervention.

Types of laparotomy

There are several types of laparotomy:

longitudinal;
oblique;
transverse;
corner;
combined techniques.

It would be useful to consider each in detail.

Longitudinal laparotomy

The longitudinal view is used in most cases. There are several variants of it (upper, central, lower middle and total), but in gynecology the lower middle is used. In this case, the incision is made from the navel to the pubic symphysis. The surgeon sees the reproductive organs after the dilation has been performed.

Oblique laparotomy

In this case, the incision is made along the arches of the ribs, from the bottom of the peritoneum or along the groin ligaments. With the help of such laparoscopy, operations are performed on the appendix, gall bladders and spleen. In gynecology, therefore, the appendages are examined.

Transverse laparotomy

Characterized by horizontal dissection. As a result, a hernia may occur as the rectus abdominal muscles intersect. This method is used for artificial delivery (caesarean section).

Angled laparotomy

Infrequently used. Usually serves as an addition to longitudinal laparotomy. After such an excision, the doctor can examine the condition of the organ in detail.

Combined laparotomy

It is advisable during extensive surgery, when access to more than just one department is needed. What excisions will be made depends on the diagnosis and nature of the pathology. Typically, such a laparotomy is indicated for operations on the adrenal glands, stomach, spleen or liver.

Contraindications for surgery

This operation is not performed if:

there are serious pathologies of the heart and lungs;
there is severe exhaustion;
poor blood clotting;
there is a shock or coma;
the appendages and uterus fall out.

Keep in mind! If, during examination, a woman has an infectious or inflammatory disease, then surgical intervention is postponed until a more favorable period, and specifically, until concomitant pathologies are eliminated.

Technique of the procedure

A few days before the operation, the patient undergoes diagnostics, which will confirm the diagnosis and eliminate all contraindications to the upcoming procedure.

A woman passes:

ultrasonography;
hysterocervicoscopy;
histology examination;
CT and MRI (if necessary, if cancer is diagnosed).

In addition to all of the above, you need to undergo general urine and blood tests.

You should not eat immediately before laparotomy. An enema is given in the evening. Surgery is performed under general anesthesia. To successfully introduce drug-induced sleep, the day before surgery the anesthesiologist talks with the patient and selects the appropriate drug.

When the woman is already under anesthesia, the doctor begins to treat the entire area that will be excised with an antiseptic.

Depending on the diagnosis, an appropriate incision is made.
The first thing that is cut is the skin, then the subcutaneous fat.
To ensure good visibility and avoid extensive blood loss, the vessels are fixed with clamps and the wound is dried.
Using surgical instruments, the wound is opened. If necessary, the edges of the muscle tissue are also retracted.
Then the surgeon dissects the abdominal area. If there is any liquid there, it begins to flow out like a fountain. To eliminate this, everything is sucked out with a special suction.
After excision of all layers, an expander is placed.
Internal organs are examined.
When pathology is visible, surgery is performed. If it is impossible to save the organ, it is removed.
At the end, drains are installed and all previously dissected tissues are sutured.

During surgery, the patient does not feel anything, as she is in a medicated sleep. When you come out of anesthesia, you may feel dizzy, nausea and weakness, but everything is purely individual. The duration of the operation depends on the diagnosis and can take from 1 to 2 hours.

Recovery period after the procedure

After surgery, it is difficult for a woman because there is a significant wound area. The patient will feel severe pain for the first 2-4 days. Simple painkillers will not be able to remove it. Doctors prescribe narcotic analgesic drugs (for example, Promedol or Tramadol) on the first day. In the future, it will be possible to switch to non-narcotic painkillers. Analgin or Paracetamol can be taken.

It is mandatory to:

listen and strictly follow all the doctor’s requirements;
wear special underwear that will prevent blood clots;
change the bandage in a timely manner (it is strictly forbidden to do this on your own, as it can cause infection);
appear at the clinic on the appointed days;
keep the area around the wound clean and do not allow water access to it;
minimize physical activity;
eat more fiber.

If healing is successful, the woman does not complain about the deterioration of the condition, the scar heals, then after 1, maximum 2 weeks, the stitches are removed.

It should be understood that laparotomy is a serious operation and the recovery period takes from one to six months. During the entire period, you should not lift weights or stay in a hot bath or sauna. You should adhere to a special diet.

If any infection occurs, then taking antibiotics cannot be avoided.

Possible consequences and complications

Sometimes after surgery, undesirable consequences may appear in the form of:

increased body temperature;
inflammatory process;
discharge from the wound surface;
changes in the consistency, color and regularity of stools;
loss of consciousness;
weaknesses;
dizziness;
vomiting and nausea;
urinary disorders;
increasing pain, swelling and redness in and around the wound area.

All of the above symptoms indicate incipient complications. In order not to worsen the situation, you should immediately go to the hospital.

Complications after laparotomy may arise due to the inexperience of the surgeon who performed the operation or due to the negligent attitude of the doctor to the patient herself.

Predisposing factors to the development of complications may also be:

smoking or alcohol abuse;
presence of diabetes mellitus;
exhaustion of the body (weak immune system);
diseases of blood vessels, heart, lungs;
pathological blood clotting;
taking certain medications without your doctor's knowledge.

If you do not consult a specialist in a timely manner, then against the background of all the above symptoms, a woman may develop serious complications in the form of:

severe bleeding, both internal and external;
infection of the wound or abdominal area;
development of blood clots.

If the operation was performed by a surgeon who does not have enough experience and does not have the appropriate qualifications, then there is a risk of injury to nearby organs. If the anesthesia is chosen incorrectly, an allergy to the drug used may develop. When the anterior wall of the peritoneum is weakened, a hernia occurs.

Is pregnancy possible after this operation?

If the uterus was removed during laparotomy, pregnancy will never occur. Another outcome if laparotomy was done to eliminate fibroids. After such an operation, you can become pregnant within 10-12 months. If the myomatous node is small, then the period can be reduced. When removing a large formation, you will have to wait a year, and sometimes more.

The muscles of the uterus must recover, and this takes time. The sutures need to dissolve, and this will take about 80-100 days. This is necessary, since as the period increases, the organ will grow and stretch; if the suture does not heal, the organ will rupture.

Delivery can be natural, but is excluded if:

the presence of gestosis;
previously removed large tumor (a large scar may burst);
duty of preliminary treatment of infertility;
pregnancy at the age of 35-40 years.

If ultrasound diagnostics showed any abnormalities, then a caesarean section is also performed.

After laparotomy, 7% of women experience uterine rupture during pregnancy and childbirth. To avoid this, you should listen to the words of the gynecologist and regularly undergo all the necessary diagnostic procedures.

Cost of the procedure in Moscow clinics

Conclusion and Conclusion

Laparotomy of the uterus helps to gain access to internal organs for diagnostic and therapeutic purposes. In this case, the peritoneum is dissected, and the surgeon clearly sees the whole problem and immediately decides what to do next. There are several types of laparotomy. The doctor may use one or a combination of them. This sometimes helps to obtain more information about the condition of neighboring organs.

The postoperative period is long and painful. You can't do without narcotic painkillers. After such an operation, a woman can become pregnant within a year, taking into account that she did not have a hysterectomy.

If the surgical intervention was entrusted to an inexperienced specialist or he was negligent in the operation, then serious complications are possible in the future. Sometimes only repeat laparotomy will help eliminate them. In some cases, undesirable consequences result from the patient’s disregard for the doctor’s words.

Laparotomy (Abdominal Exploration; Laparotomy, Exploratory)

Description

Laparotomy is an opening of the abdominal wall to examine the organs and tissues inside the abdomen.

Reasons for laparotomy

This procedure is performed to evaluate the condition of the abdominal cavity.

Problems for which laparotomy is indicated include:

A hole in the intestinal wall (ulcer);
Ectopic (ectopic) pregnancy;
Endometriosis;
Appendicitis;
Damage to internal organs due to trauma;
Infection in the abdominal cavity;

Possible complications during laparotomy

Complications are rare, but no operation guarantees the absence of complications. If laparotomy is planned, possible complications may include:

Bleeding;
Infection of the incision;
Blood clots;
Damage to internal organs;
Hernia formation;
Large scars;
Negative reaction to anesthesia.

Factors that may increase the risk of complications:

Previous abdominal surgery;
Diabetes;
Heart and lung diseases;
Weak immune system;
Disturbances in the circulatory system;
Taking certain medications;
Smoking, alcohol abuse, drug use.

The risk of complications must be considered before undergoing the procedure.

How is laparotomy performed?

Before surgery

Preparation for the procedure:

Before the operation, the following examinations must be performed:

Conduct a physical examination;
Do blood and urine tests;
Perform an ultrasound, a test that uses sound waves to see the inside of the body;
Conduct a computed tomography scan - an x-ray examination that uses a computer to take photographs of internal organs;
MRI is a test that uses magnetic waves to see internal organs.

You may need to stop taking certain medications one week before your procedure:

Do not take anti-inflammatory drugs (for example, aspirin);
Do not take blood thinners such as clopidogrel (Plavix) or warfarin.

Do not eat food the day before the procedure.

Anesthesia

The procedure is almost always performed under general anesthesia.
Spinal anesthesia is used for possible complications from the use of general anesthesia - the area from the chest down to the legs is anaesthetized.

Description of the laparotomy procedure

The doctor will make one long incision along the abdomen. Organs are examined for the presence of disease. The doctor may take a biopsy of the organ of interest. During laparotomy, the necessary surgical intervention can be performed. After laparotomy, the incision is sutured with threads or secured with staples.

How long does a laparotomy take?

Approximately 1-4 hours.

Will it hurt?

Anesthesia prevents pain during the procedure. To reduce pain after the procedure, you must take painkillers.

The average hospital stay is several days. If complications arise, the period increases.

Caring for the patient after surgery

In the hospital

You may need to wear special socks or shoes to prevent blood clots;
You may need to use a catheter to help you urinate;
You can use an incentive spirometer to help you breathe deeper.

At home

It may take several weeks for the body to fully recover.

Follow your doctor's orders;
Sutures or staples are removed after 7-10 days;
Avoid infection at the incision site;
You need to wash and bathe with caution so that water does not get into the wound;
For the first two weeks after surgery, do not lift objects;
Slowly increase the intensity of your movements. Start with light housework, short walks;
To help your incision heal faster, eat plenty of fruits and vegetables.

Try to avoid constipation:

Don't eat foods high in fiber;
Drink plenty of water;
Take laxatives if necessary.

You should immediately go to the hospital in the following cases:

The appearance of fever or chills;
Redness, swelling, severe pain, bleeding, or any discharge from the incision site;
Bloating;
Diarrhea or constipation that lasts more than 3 days;
Bright red or dark black stools;
Dizziness or fainting;
Nausea and vomiting;
cough, shortness of breath, or chest pain;
pain or difficulty urinating;
Swelling, redness, or pain in the legs.

Laparotomy (chromectomy) – a mandatory stage of all operations on the abdominal organs. In some cases, it serves as access to a specific organ or pathological process, in others it is used to inspect the abdominal organs in order to exclude damage to internal organs or determine the possibility of surgery for a tumor process.

Anesthesia . For small laparotomies (Dyakonov-Volkovich access for appendectomy), local anesthesia is used. For midline laparotomy, oblique incisions in the hypochondrium, pararectal approaches, as well as for technically difficult appendectomy from a typical approach, modern endotracheal anesthesia with the use of muscle relaxants is preferable.

Accesses. Most often, an incision is used in the midline of the abdomen - median laparotomy.

At upper midline laparotomy, T . That is, an incision along the midline above the navel, dissects the skin, subcutaneous tissue, aponeurosis (or linea alba), preperitoneal tissue and peritoneum. This incision provides access to the organs of the upper abdominal cavity. Lower middle sectionalso runs along the linea alba, however, after dissecting the linea alba, which is very narrow below the navel, it is often necessary to use Farabeuf plate hooks to retract the edges of the rectus muscles. The incision provides access to the intestines and pelvic organs. At midmedian laparotomy the incision starts above the navel, goes around the navel on the left and ends 3-4 cm below it. This access is intended for revision of the entire abdominal cavity: if necessary, it can be extended up or down.

Progress of laparotomy operation

1. Dissection of skin and tissue. An incision is made into the skin and subcutaneous tissue, for which the surgeon is given a sharp abdominal scalpel. This scalpel becomes dirty when cutting the skin, so the operating nurse immediately throws it with a forceps into the basin with the used instrument. When the incision is made, the wound needs to be dried - give the assistant a gauze ball (tuffer) on a forceps or clamp, and the operating surgeon - hemostatic clamps one after another until all the bleeding vessels are captured.

After the bleeding has stopped, the nurse provides 2 napkins to isolate the surgical wound from the skin - the napkins are placed along the edges of the incision and secured at the corners with clamps. For large laparotomies, before placing napkins, it is necessary to lubricate the skin around the wound with cleol so that the napkins stick along the entire length of the incision and reliably isolate the skin. For better fixation, the skin must be wiped dry with a separate cloth before treatment with cleol. Hemostats placed in the subcutaneous tissue can be left until the end of a minor operation, but it is always best to aim for as few instruments as possible in the surgical area. To completely stop the bleeding, the vessels are ligated. To do this, the nurse gives the assistant blunt-ended curved scissors for cutting the threads, and the surgeon sequentially - ligatures made of catgut No. 2, each 18 - 20 cm long. The hemostatic clamps returned by the assistant (necessarily with a latched ratchet lock - the nurse must monitor this) can be used again, wiping them with a sterile napkin and thus clearing them of blood.

2. Dissection of the aponeurosis. The assistant uses sharp hooks to spread the edges of the skin wound. To dissect the aponeurosis, the nurse gives a clean scalpel, with which the surgeon makes a small incision in the aponeurosis, and then curved scissors, with which the surgeon finishes dissecting the aponeurosis up and down. After dissection of the aponeurosis, the peritoneum, covered with peritoneal tissue, is exposed to the surgeon. To clearly see the peritoneal layer below the umbilicus, it may be necessary to retract the edges of the rectus abdominis muscles with plate hooks.

3. Dissection of the peritoneum. To dissect the peritoneum, the nurse hands the surgeon and anatomical assistant tweezers: with these tweezers, the peritoneum is folded and cut with scissors. Once a small hole is made in the peritoneum, two Mikulicz forceps need to be applied: one to the surgeon and one to the assistant. They grab the edges of the peritoneum and fix them to the edge of the side sheets. Moreover, if there is a large amount of exudate or blood in the abdominal cavity, the contents under pressure can flow out, flooding the surgical field and contaminating the wound. Therefore, the nurse should have an electric suction device or a sufficient number of large tampons on forceps ready at the time of opening the abdominal cavity.

As the peritoneum is cut up and then down with Cooper scissors, the sister applies another 4-6 Mikulicz clamps so that the edges of the peritoneum along its entire length are securely fixed to the surgical linen, covering the subcutaneous tissue. If, at the time of opening the abdominal cavity, the intestines interfere with the dissection of the peritoneum, the nurse, at the request of the assistant, provides a tuffer to remove the intestinal loops.

4. Revision of the abdominal organs. The next important stage of laparotomy as an independent operation is a thorough examination of the entire abdominal cavity. At this stage, when the surgeon is focused on detecting pathology, the nurse must carefully ensure that no napkins, balls or other foreign bodies are left in the abdominal cavity during manipulation.

The nurse should have saddle-shaped hooks ready to lift the abdominal wall, liver and abdominal speculum. To widen the edges of the wound and hold them in this position, the nurse applies a retractor, most often the Gosse type. She first prepares two small napkins, which the surgeon places under the hooks of the retractor to reduce pressure on the tissue. These napkins must be well fixed and must be remembered so that at the end of the operation you do not forget to throw them away after removing the retractor. For any laparotomy, hot saline solution should always be available. If there is effusion in the abdominal cavity, the nurse gives the surgeon a small ball to culture the contents for microbial flora.

5. Mesenteric root block. Before suturing a wound of the anterior abdominal wall, in most cases it is necessary to perform a novocaine blockade of the root of the mesentery of the small intestine. To do this, you need to have a syringe with a capacity of 10 or 20 ml with a thin long needle and 150-200 ml of a 0.25% novocaine solution.

6. Installation of drains through a counter aperture. If indicated, the surgeon decides to leave a rubber drain in the abdominal cavity. Microirrigators for administering antibiotics are usually removed through the corners of the midline incision. To avoid infection of the median suture, drains are removed through a counter-aperture in the lateral part of the abdominal wall. To do this, shift the Mikulicz clamps, freeing the edge of the sheet on the corresponding side and exposing the skin in the hypochondrium or iliac region. The nurse provides a stick with an antiseptic for treatment and a pointed scalpel, with which the surgeon pierces the skin in the intended place. After this, the nurse applies a pointed clamp, the assistant lifts the edge of the abdominal wall and the surgeon, under eye control, pierces all layers of the abdominal wall from the outside in with the clamp. At this point, the nurse should provide a rubber drainage prepared in advance with two to three holes at the end, the end should be rounded. If a different type of drainage is needed, the surgeon himself prepares it in advance or explains in detail what exactly is needed.

The surgeon fixes the drainage with jaws of the clamp and pulls it through the abdominal wall from the inside to the outside, leaving it in the abdominal cavity to the desired length. The nurse then delivers a needle holder with a cutting needle loaded with silk thread to secure the drainage to the skin. After this, the skin is carefully covered again with surgical linen and the surgeon begins to suture the wound of the anterior abdominal wall.

7. Suturing a wound of the anterior abdominal wall. First, the peritoneum is sewn with a continuous catgut suture. The surgeon shifts the Mikulicz clamps, freeing the side edges of the sheets. The sister feeds catgut No. 6 up to 50 cm long on a medium-sized cutting needle. After tying a continuous catgut thread, its ends are cut off.

The operating surgeon and the assistant, if necessary, treat the gloves with an antiseptic solution, the nurse changes the instruments and unfolds the towel lying on the patient with a clean side. Then interrupted silk sutures are applied to the aponeurosis. It is necessary to feed silk threads No. 6 or even No. 8 20-25 cm long on a large cutting needle. Sometimes suturing the peritoneum is difficult due to high tissue tension. In such cases, the surgeon can apply 3-4 interrupted silk sutures to the aponeurosis along with the peritoneum.

After suturing the aponeurosis, the nurse gives a stick with an antiseptic, the surgeon discards the napkins that isolate the skin and carefully treats the wounds with an antiseptic.

Sparse catgut (No. 2) sutures are usually placed on the subcutaneous tissue and superficial fascia. The nurse must take into account the thickness of the subcutaneous layer and apply the threads with a sufficiently long needle. The operation is completed by placing interrupted silk sutures on the skin using silk No. 4 on a strong cutting needle. When stitching the skin around the navel, the needle in the needle holder should be fixed further from the ear, since due to the high density of the skin in this area, the needles often break.

Laparotomy is a surgical procedure that involves making an incision in the anterior abdominal wall to examine and treat the abdominal organs and to diagnose the cause of lower abdominal pain.

In this article we will find out what laparotomy is, its features and possible risks.

Abdominal laparotomy and popular one have their advantages, but each operation also has a disadvantage. For those who do not know what laparoscopy is, it should be noted that it is a surgical procedure, but it does not require any incisions to be made in the abdomen. It is enough to make 2-3 minor punctures through which instruments and a video camera are inserted into the abdominal cavity. Under these conditions, the doctor performs microsurgical manipulations.

Despite the significant advantages of laparoscopy, patients are often prescribed laparotomy surgery. It has differences that are its advantage:

Technical simplicity of the operation.
No complex equipment required.
This surgical procedure is convenient for the surgeon.

Indications for laparotomy

Not everyone has indications for laparotomy. A similar operation is prescribed in the following situations:

ovarian cysts;
ectopic pregnancy;
purulent fallopian tubes or ovaries;
peritonitis;
development of tumors of the reproductive organs;
ovarian dysplasia;
tubo-peritoneal infertility.

As a rule, it is not difficult for women who go to the doctor with complaints about it to make a diagnosis. For this purpose, standard tests and ultrasound are prescribed. But sometimes a detailed examination is required to clarify the diagnosis. For example, the surgeon may need to determine the location of a sudden ulcer rupture or determine the cause of internal bleeding or find a node. Exploratory laparotomy is an opportunity to determine the exact cause of the patient’s complaints and prescribe appropriate treatment. Anesthesia is required for such an intervention.

Types of laparotomy

Laparotomy can be performed in several ways. Types of laparotomy:

Pfannenstiel laparotomy

Laparotomy according to Cherny. This type involves making an incision along the line exactly between the pubic bone and the navel. The so-called Cherny laparotomy involves transverse interiliac transection. This method is used for tumor pathologies, for example, if uterine fibroids have developed. The advantage of this method is that the surgeon can expand the incision lines at any time convenient for him and access to organs and tissues will be increased.
Laparotomy according to Pfannenstiel. The preferred method used in gynecology. Transverse suprapubic transection is assumed. The incision will be along the lower line of the abdomen. The scar remaining along the incision line will not be noticeable.
Laparotomy according to Joel-Cohen. It involves making a transverse incision made 2-3 cm below the middle of the distance between the navel and pubis. Implementing such mini-access is very convenient.

Preparing for surgery

Surgery requires preparation. The doctor must collect as much necessary information about the patient as possible. That is why a woman should answer the doctor’s questions as accurately as possible. This applies, at a minimum, to lifestyle, harmful addictions, medication and diet.

After laparotomy, the doctor instructs the patient that certain procedures will definitely need to be completed, and also expresses his predictions regarding the period after surgery.

The anesthesiologist who will administer the anesthesia must also ensure that the patient is ready for surgery.

Laparotomy, features of the operation

To begin with, anesthesia is administered. As a rule, all abdominal operations, and laparotomy is no exception, are performed after general anesthesia has been administered.
The surgical technique is as follows:

As soon as the anesthesia wears off, the patient will regain consciousness.

Recovery after surgery

To ensure that a woman does not encounter complications or undesirable consequences after surgery, and that her recovery is faster, she needs to follow certain instructions prescribed by the doctor.

While in the hospital, the patient must:

follow all doctor's orders;
use special shoes to reduce the risk of blood clots;
Often (though not always) it is necessary to urinate through a special catheter.
in severe situations, a special incentive spirometer can be used to improve breathing.

Important! The patient is prohibited from independently examining the wound, removing bandages, or touching drains. There is a high chance that an infection may occur.

How long a woman will stay in the hospital depends on the characteristics of the disease for which the surgical intervention was performed. If the patient goes home soon after the operation, she must also adhere to certain rules:

follow all doctor’s instructions, including regarding the timing of hospital visits;
Maintain maximum hygiene in the wound area;
Water should not get into the postoperative suture site;
reduce the amount of physical activity to a minimum;
Do not lift heavy objects under any circumstances, as the seams may come apart;
A diet of predominantly fruits and vegetables must be followed.

Usually 5-7 days after surgery the sutures are removed. However, after this you need to be extremely careful about your condition. If you notice a number of symptoms, you should immediately consult a doctor:

in case of elevated temperature;
if inflammation or strange discharge appears in the operation area;
bowel dysfunction that continues for 2-3 days;
the chair has changed its properties (for example, color);
general condition worsened (weakness, dizziness appeared);
nausea, vomiting;
problems with urination;
swelling appeared, which is in no hurry to subside, redness, pain in the legs.

A laparotomy operation performed with the symptoms described above is evidence of complications.

Many patients are afraid that the stitches may come apart. They should not diverge if you follow all the doctor’s recommendations. However, every patient should know the answer to the question of what to do if the suture suddenly breaks after surgery.

In this case, the main thing is not to panic. Examine the wound, incision lines and call an ambulance immediately. While you wait, the edges of the wound can be covered with a bandage to stop further dehiscence.

Possible complications

Laparotomy in gynecology can result in complications under certain circumstances. For example, when performing an operation on the uterus, the possibility of damage to neighboring organs cannot be ruled out. The laparotomy procedure being performed increases the risk of adhesions. This happens due to the fact that in the process of performing surgical actions, the instruments have to touch the peritoneum, as a result a process can begin and adhesions appear on the peritoneum, “gluing” the organs together.

A serious complication is bleeding, which can be caused by various reasons.

Laparotomy with myomectomy

Laparotomy as a conservative myomectomy, otherwise known as enucleation, is carried out through a longitudinal cavity incision. Myomatous nodes are removed while preserving the uterus. Laparotomy with conservative myomectomy is prescribed in the same cases as laparoscopy, but only because the latter is not possible due to the lack of technical capabilities.

In modern gynecology, laparotomy through conservative myomectomy is recommended in the presence of large myomatous nodes that deform the uterine cavity, the presence of pelvic pain, discomfort in the abdominal area, uterine fibroids, bleeding, dysplasia and other pathologies.

Laparotomy with conservative myomectomy is performed if there are no more than 4 myomatous nodes.

Before a laparotomy with conservative myomectomy is prescribed, the doctor conducts the necessary examination.

How is the operation performed? The patient is given anesthesia. After the incision, the uterus is brought into the wound, where it is fixed, cut, and all the necessary manipulations are performed on it. The existing myomatous nodes are excised and desquamated.

In the postoperative period, the woman is prescribed pain relief. The patient requires care for some time. If there were no complications, then she is discharged in the second week, after 9-11 days. From this moment the rehabilitation period begins. The menstrual cycle is quickly restored after surgery. After rehabilitation, after 2 months. you will need to do an ultrasound.

Laparotomy, namely resection of the ovary, involves surgical intervention on this organ in order to remove part of it. Menstruation is not disrupted.