EXPLORATORY LAPAROTOMY

Abdominal exploration is surgery to look at the organs and structures in your belly area
(abdomen). This includes Uterus, fallopian tubes, and ovaries (in women) and other abdominal
cases.
Surgery that opens the abdomen is called a laparotomy.

Purpose
Exploratory laparotomy is a method of abdominal exploration, a diagnostic tool that allows
physicians to examine the abdominal organs. The procedure may be recommended for a patient
who has abdominal pain of unknown origin or who has sustained an injury to the abdomen.
Because of the nature of the abdominal organs, there is a high risk of infection if organs rupture
or are perforated. In addition, bleeding into the abdominal cavity is considered a medical
emergency. Exploratory laparotomy is used to determine the source of pain or the extent of
injury and perform repairs if needed.

.
An ovarian cyst is a sac filled with liquid or semiliquid material that arises in an ovary. Although
the discovery of an ovarian cyst causes considerable anxiety in women owing to fears of
malignancy, the vast majority of these lesions are benign.

Persistent simple ovarian cysts larger than 10 cm (especially if symptomatic) and complex
ovarian cysts should be considered for surgical removal. The surgical approaches include an
open technique (laparotomy) with incisions. The latter approach is preferred in cases presumed
benign. Removing the cyst intact for pathologic analysis may mean removing the entire ovary,
though a fertility sparing surgery should be attempted in younger women.
PRE-OPERATIVE
Health and Physical Assessment

Patient Name: J.A

Age: 29

Sex: Female

Pre-Op Diagnosis: Inner abdominal mass left S/P CA G2P2

Physical Assessment:

Vital signs:
BP: 110/90
T: 36.4
PR: 80
RR: 18
O2Sat: 97%

Head- is normocephalic, hair is well distributed.

Neck- is in midline

Eyes- teary- eyed, symmetric and PERRLA

Ears-are symmetric, cerumen noted on both ears, responsive to verbal cues, no lesions noted on
both ears.

Nose- is at midline, intact nasal septum.

Lips- pale and dry

Teeth- crooked.

Skin- is fair in color.

Nails- clean and trimmed, pale nail beds

Abdomen- lump is palpated on the left quadrant.

Arms, legs- no edema palpated

INTRA-OPERATIVE

Exploratory Laparotomy

Midline incision and opening of peritoneum a vertical midline incision is the best choice:
It affords a rapid entry into the peritoneum and is relatively bloodless and safe. The incision may
be made in the upper, middle, or lower midline, depending on the anticipated pathology, and
may be extended in either direction if necessary. Exposure of the peritoneum should never be
compromised in an attempt to keep the incision small. The skin is incised with a surgical knife.
Electrocautery can be used instead of the traditional scalpel for making the incision, as skin
incisions made by cutting diathermy are quicker, are associated with less blood loss, and
demonstrate no significant difference in the rate of wound complications, scar cosmesis, or
postoperative pain. The incision is then deepened through the subcutaneous fat. Electrodiathermy
in coagulation mode provides a bloodless access through this layer. The linea alba is identified as
a glistening layer deep to the subcutaneous tissues. The orientation of the fibers on the linea alba
is appreciated; these fibers are directed medially and inferiorly from either side, and the midline
is identified as the axis where they criss-cross. This is opened carefully by means of
electrodiathermy or heavy Mayo scissors. Every effort must be made to avoid injury to the
intraperitoneal contents. This can be done by lifting the peritoneum in two straight artery forceps
placed close to each other at right angles to the incision. Use careful palpation to ensure that no
bowel or omentum is picked up in the artery forceps. In reoperations, extreme care is necessary
because the underlying bowel may be adherent to the parietal peritoneum. In these cases, the
peritoneum is opened in a virgin area, preferably by extending the incision appropriately. Once
the procedure is completed, the abdominal wall is closed. Before closure, however, the
instrument and pad counts must be double-checked. The surgeon should manually inspect the
peritoneum for any retained pads or instruments, even if scrub nurse has found the count to be
correct. Closure is carried out with either nonabsorbable suture material (eg, polypropylene) or a
delayed absorbable suture material (eg, polydioxanone) in either a continuous suture or
interrupted sutures. The standard approach is to place sutures about 1 cm from the edge of the
incised linea alba, maintaining a distance of 1 cm between successive bites. Sometimes, the
Smead-Jones closure technique (ie, single-layer mass closure) may be employed to close the
abdomen if the abdominal wall is plastered and separate layers are unavailable as a result of
previous operations. This technique makes use of figure-eight sutures. At times, closure may be
rendered difficult by an edematous or distended bowel. In such circumstances, forced closure
may have adverse postoperative outcomes in the form of impaired ventilation, intra-abdominal
hypertension, pain, and dehiscence. Laparostomy and delayed closure may be a better option in
such cases.
POST-OPERATIVE COMPLICATIONS and MANAGEMENT

Exploratory Laparotomy

An exploratory laparotomy is associated with the same complications that are associated with
any laparotomy. Immediate complications include the following:

Paralytic ileus

 Intra-abdominal collection or abscess

 Wound infections
 Abdominal wall dehiscence
 Pulmonary atelectasis
 Entero-cutaneous fistula

Delayed complications include the following:

 Adhesive intestinal obstruction

 Incisional hernia

MANAGEMENT:

 Nurses will closely watch your condition. When you are more awake and alert, you will be
moved to another room.
 Nurses must monitor patient not to eat food or drink until the patient’s bowels start to work
normally again.
 Nurses should teach patient breathing exercises to do. These help prevent pneumonia.
 Nurses should make sure that the incision site is cleaned and should teach the patient on how to
do proper cleaning of the wound.
 Nurses should administer medicines as prescribed to help prevent infection and to
manage pain.
perform early ambulation.