Exploratory Laparotomy: Overview
An exploratory laparotomy, also known as a celiotomy or “ex lap,” is a type of major surgery that involves opening the abdomen with a large incision in order to visualize the entire abdominal cavity. Your abdominal cavity contains a variety of organs and tissues, including the intestines, appendix, stomach, ovaries, and kidneys, to name a few. An exploratory laparotomy is done to diagnose and possibly treat related issues that cannot otherwise be seen (and sometimes, managed) through less-invasive methods.
What Is Exploratory Laparotomy?
An exploratory laparotomy is an open surgery performed by a general surgeon in a hospital under general anesthesia. The surgery can be done in adults and children, and may be performed emergently (e.g., for a life-threatening acute abdomen or abdominal trauma) or electively (e.g., to evaluate chronic abdominal pain).
The precise timing of the operation depends on the reason for the surgery and what is found during surgical exploration.1
Various Surgical Techniques
While an exploratory laparotomy is traditionally an open surgery, this surgery can also be performed laparoscopically.2
In fact, exploratory laparoscopic surgery is more frequently utilized today. It is a minimally invasive method in which the surgeon makes multiple tiny incisions in the abdomen through which long, thin surgical instruments are inserted. One of the instruments has a camera attached to it, allowing the surgeon to visualize the organs and tissues inside the body through images projected onto a TV screen.
The decision to perform the procedure open or laparoscopically rests with the surgeon and what, if anything, they expect to find during surgery.
In the majority of cases, the open technique is reserved for the following circumstances:3
When time is of the essence (emergency situations)
When the patient is unstable
When the procedure requires a large incision, such as when a large portion of the intestine needs to be visible and accessible
Trauma, such as a car accident or a penetrating injury (stabbing or gunshot wound), is a frequent cause of abdominal injuries that must be diagnosed or treated with a traditional laparotomy, as opposed to a laparoscopic approach.4
There are no absolute contraindications to undergoing an exploratory laparotomy. However, patients with certain serious health concerns—multiple medical problems, sepsis, or widespread metastatic cancer—may not be good candidates.3
Purpose of Exploratory Laparotomy
The purpose of an exploratory laparotomy is to determine the source of/reason behind a person’s symptoms by directly exploring abdominal organs and tissues, which may be diseased, injured, or contain abnormal growths.
In some cases, tissue biopsy and/or treatment of the underlying problem is also performed during the same surgery.
Exploratory laparotomy may be used to explore the following organs and structures:
Large and small intestines
Female reproductive system (e.g., fallopian tubes, ovaries, and uterus)
Abdominal lymph nodes and blood vessels
Examples of diagnoses that may result from a surgeon performing an exploratory laparotomy include:1
A perforation (hole) or blockage in the stomach or intestines
Inflammation, infection, or rupture of the appendix (appendicitis)
Liver disease, infection, or trauma
Injury to the spleen, intestines, stomach, or bladder
Blood vessel injury
Cancer of an organ, such as ovarian cancer
How to Prepare
Prior to your surgery, you will meet with your surgeon and a nurse from the anesthesia team. During these appointments, be sure to inform them of any allergies you have and all the medications you are taking.
These types of medications include the following:
Vitamins, herbals, or supplements
Once your surgery is scheduled, your surgeon will provide you with instructions on how to prepare for the operation.
These instructions may include the following:
Arrival time for your surgery and what to wear and bring with you
Which medications to continue and/or stop prior to surgery
Lifestyle habits to adopt prior to surgery (e.g., stop smoking and drinking alcohol)
When to stop drinking and eating before your surgery
Getting Ready for Surgery the Right Way
It’s important to keep in mind that for emergent exploratory laparotomies, the preparation protocol is different because the patient has a potentially life-threatening condition.7 In these time-sensitive situations, the healthcare team must balance carrying out therapies that will optimize the patient’s outcome, while not delaying surgery unnecessarily.
Some of these preparatory strategies may include administering:
Fluid and electrolytes
What to Expect on the Day of Surgery
During an exploratory laparotomy, you can expect the following steps:
Upon arriving at the hospital, you will be taken into a room where you will change into a gown.
A nurse will place a small tube (an IV catheter) in a vein in your arm. You will then be taken into an operating room and given medication to put you to sleep.
Once the anesthesia takes effect, the skin of the abdomen will be prepared with an antibacterial solution to help prevent infection at the surgical site.
The surgeon will then make an incision (usually a vertical one down the middle of the abdomen).8
Next, the organs and tissues will be inspected for signs of disease, infection, and injury. Biopsies of different tissues may be taken, if needed. In some cases, the abdominal cavity may be “washed,” where a sterile fluid is placed in the abdomen and then collected for further study.
Once the organs and tissues of the abdomen have been inspected, the “look and see” portion of the procedure is over; however, in many cases, an additional procedure will be performed. For example, a laparotomy may be performed to find the source of abdominal pain. If an inflamed appendix is found, an appendectomy procedure would then be done.
The incision may be closed in a variety of ways. Larger incisions are typically closed with sutures or staples, while smaller ones may be closed with adhesive wound closure strips or surgical glue.
The incision is then covered with a sterile surgical bandage. Anesthesia is stopped and you are taken to a recovery area.
While the recovery time for an exploratory laparotomy varies based on the extent of the surgery, you can expect to stay in the hospital for approximately five to 10 days. Full recovery from an exploratory laparotomy may take four to six weeks.9
Emergent exploratory laparotomies performed as a result of trauma (for example, a patient who was in a car accident with internal bleeding) may require a longer healing period.
Likewise, a patient with cancer may have a more complicated recovery, as the treatment for their cancer may overlap with recovery. The same is true when having an additional surgical procedure with the laparotomy.
Once discharged from the hospital, in order to maximize healing after surgery and to minimize the possibility of complications, it’s important to carefully follow your surgeon’s instructions for post-operative care.
Some of these instructions may include the following:
To control pain, take Tylenol (acetaminophen) or, if more significant, your prescribed opioid as directed.
To prevent infection, wash your hands before and after touching your incision site(s).
When showering, let the water run over the incision site and pat the site dry; avoid soaking in a bath or hot tub.
Take anti-nausea and anti-constipation medications as advised.
When to Seek Medical Attention
As you recover from surgery, contact your surgical team right away if you notice any of the following symptoms:10
Signs of infection around the surgical site (e.g., increased tenderness, redness, warmth, or abnormal discharge from the wound)
Fever, chills, or muscle aches
Persistent or worsening abdominal pain or swelling
Nausea or vomiting
Difficulties with urination or having a bowel movement
Seek medical attention emergently if you experience fainting, trouble breathing, or swelling or pain in your legs.
Once you are finished with the immediate recovery from an exploratory laparotomy, you may need further treatments, including additional surgeries, based on the surgeon’s findings. In order to move forward with any additional therapies, and to ensure you are healing well, you will likely have multiple follow-up appointments.
No doubt, the entire process from the start of surgery to recovering from it can be time-intensive, as well as physically and emotionally taxing. Try to lean on loved ones during this time.
In addition to the general risks of anesthesia and surgery (e.g., blood clots, pneumonia), an exploratory laparotomy poses its own risks.
Of course, the precise risks vary based upon the underlying problem or disease that makes the procedure necessary. Generally speaking, though, complications that may occur include the following:1
Wound infection or dehiscence (when the wound site reopens)
Collection of infected fluid that forms within the abdomen (intra-abdominal abscess)
Fistula formation: For example, an enterocutaneous fistula, which is an abnormal pathway that forms between the intestines or stomach and the skin
Damage to abdominal organs
Nerve damage leading to skin numbness
Due to advancements in imaging techniques and medical therapies, exploratory laparotomy is probably less commonly performed than it was in the past. Regardless, this type of surgery remains a cornerstone for treating various, oftentimes life-threatening conditions.