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Concept
Laparotomy
Summary
A laparotomy is a surgical procedure involving a surgical incision through the abdominal wall to gain access into the abdominal cavity. It is also known as a celiotomy.
The first successful laparotomy was performed without anesthesia by Ephraim McDowell in 1809 in Danville, Kentucky. On July 13, 1881, George E. Goodfellow treated a miner outside Tombstone, Arizona Territory, who had been shot in the abdomen with a .32-caliber Colt revolver. Goodfellow was able to operate on the man nine days after he was shot, when he performed the first laparotomy to treat a bullet wound.
The term comes from the Greek word λᾰπάρᾱ (lapara) 'the soft part of the body between the ribs and hip, flank' and the suffix -tomy, from the Greek word τομή (tome) '(surgical) cut'.
In diagnostic laparotomy (most often referred to as an exploratory laparotomy and abbreviated ex-lap), the nature of the disease is unknown, and laparotomy is deemed the best way to identify the cause.
In therapeutic laparotomy, a cause has been identified (e.g. colon cancer) and the operation is required for its therapy.
Usually, only exploratory laparotomy is considered a stand-alone surgical operation. When a specific operation is already planned, laparotomy is considered merely the first step of the procedure.
Depending on incision placement, laparotomy may give access to any abdominal organ or space, and is the first step in any major diagnostic or therapeutic surgical procedure of these organs, which include:
the digestive tract (the stomach, duodenum, jejunum, ileum and colon)
the liver, pancreas, gallbladder, and spleen
the bladder
the male prostate
the female reproductive organs (the uterus and ovaries)
the retroperitoneum (the kidneys, the aorta, abdominal lymph nodes)
Surgical Incisions
The most common incision for laparotomy is a vertical incision in the middle of the abdomen which follows the linea alba.
The upper midline incision usually extends from the xiphoid process to the umbilicus.
A typical lower midline incision is limited by the umbilicus superiorly and by the pubic symphysis inferiorly.
Official source
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