Laparotomy

What is a laparotomy?

A laparotomy is a surgical procedure that opens up your abdomen to expose your organs.

Sometimes, a laparotomy is exploratory — a way for your surgeon to see what’s going on inside your body and possibly take tissue samples in order to diagnose your condition. It can also be therapeutic — a way of treating some conditions. You may need open surgery to remove an organ or to manage a critical condition, or your surgeon may find and fix a problem while they’re exploring.

The term “laparotomy” actually refers to the incision through your abdominal wall that opens up your peritoneal cavity — the cavity that includes your abdomen and pelvis. But you’ll often hear the term used to describe an open exploratory procedure. Other terms for laparotomy include “celiotomy” (an incision into your abdomen) and “peritoneotomy” (an incision into your peritoneal cavity).

What is the difference between a laparotomy vs. a laparoscopy?

Laparotomy and laparoscopy are two different methods for surgically exploring the inside of your abdomen.

Laparoscopic surgery is an alternative to open surgery. Instead of opening up your abdomen to expose your organs, laparoscopic surgery works by inserting a laparoscope, a tiny lighted camera, through a small “keyhole” incision in your abdomen. Your surgeon operates through other keyholes, using the camera as a guide. A laparoscopy is an exploratory surgery similar to a laparotomy, using a laparoscope.

Each method has its benefits and drawbacks. Laparoscopy is less invasive and easier to recover from, making smaller wounds and leaving smaller scars. However, it requires special training and equipment, and it takes longer, which may not work in an emergency. A laparotomy is a standard procedure that any hospital can provide. In certain cases, it’s also more practical for managing critical conditions.

Why would you need a laparotomy?

Your surgeon might need to explore your peritoneal cavity to find the source of a problem, such as unexplained abdominal pain or internal bleeding, if they haven’t been able to find it on imaging tests. They might need access to everything if they don’t know where the issue is located or how widely it might be spread. They might choose laparotomy over laparoscopy if your condition appears urgent.

Laparotomy is often an emergency procedure, but not always. You might have a laparotomy for a planned or unplanned C-section. Your surgeon might schedule a laparotomy to remove an organ or to remove cancer. It’s also helpful for cancer staging, to find out how far cancer may have spread from its original location. This is a “staging laparotomy.” They also might need to take tissue samples for biopsy.

What organs does an abdominal exploration examine?

Your surgeon might need to look at your:

• Stomach.
• Intestines.
• Appendix.
• Spleen.
• Pancreas.
• Liver.
• Gallbladder.
• Bile ducts.
• Kidneys, adrenal glands and ureters.
• Bladder.
• Female reproductive organs (uterus, fallopian tubes and ovaries).

What procedures or conditions might require a laparotomy?

Some examples include:

• Traumatic abdominal injury.
• Infection in your peritoneal cavity (peritonitis).
• Gastrointestinal perforation or uncontrolled gastrointestinal bleeding.
• Emergency appendectomy for complicated appendicitis.
• Emergency splenectomy for a ruptured spleen.
• Ovarian cystectomy for ovarian cysts or ovarian endometrioma.
• Endometriosis staging and treatment (endometriosis surgery).
• Whipple procedure or total pancreatectomy for pancreatic cancer.
• Ovarian cancer staging and treatment.
• Hodgkin lymphoma staging and treatment.

Is a laparotomy a major surgery?

Yes. Whether it’s an exploratory laparotomy or it’s for a limited purpose, such as removing an organ, opening up your peritoneal cavity is major surgery. The incision will be long and deep, and many layers of your tissue will have to be repaired and healed. You’ll recover in stages, in the hospital and at home. The specifics of your condition and what happens during the procedure will also affect your recovery.

What happens before a laparotomy?

Preparation before surgery includes:

• Informed consent. Your surgeon will describe the procedure, the possible risks and alternatives and the intended outcome. They’ll ask for your signed consent to proceed if you’re able. If you aren’t, they’ll document your mental capacity at the time and discuss it with your next of kin.
• Physical assessment. If possible, your surgeon will take a survey of your current health conditions and medications and any prior surgeries. They’ll take some basic medical tests, such as X-rays and blood tests, to make sure surgery and general anesthesia are safe for you.
• Bowel prep. Depending on the operation, you may need to clear out your bowels ahead of time. Your healthcare team may give you a bowel prep kit containing a laxative formula, or an enema, prior to your surgery. You may have to avoid eating or stick to a clear liquid diet the day before.
• Sterilizing. Immediately before the procedure, a healthcare provider may give you a surgical scrub to use in the shower to clean and sterilize your abdomen. Or they might clean you themselves. They might shave the area to clear it of any microorganisms that might be hiding in your body hair.

What happens during a laparotomy?

A laparotomy involves a large incision of three to 12 inches into your abdominal cavity. The specifics of the incision, and what happens after, will depend on the purpose of your laparotomy. In general, you can expect to be in surgery for several hours. You may have various tubes installed in different parts of your body to deliver and drain fluids, and these will stay in place for several days. These may include:

• A catheter connected in your vein to deliver anesthesia, antibiotics and IV fluids.
• A nasogastric tube inserted through your nose to your stomach to drain fluids.
• A urinary catheter to drain your bladder.
• In some cases, you may need a surgical drain, feeding tube or parenteral nutrition (through an IV).

What are the different types of laparotomy?

A laparotomy for a specific purpose, such as an exploratory laparotomy or a staging laparotomy, might have its own set of standardized steps. But often, your surgical team won’t know all the steps they’ll need to do until they’re in surgery. So, not every variation of the procedure is a standardized type.

There are also different types of laparotomy incisions that your surgeon might use for different purposes. While a midline incision through your abdomen is most common, giving your surgeon access to all of your organs, your surgeon might use a different incision to focus on the organs in a specific area.

Laparotomy incisions

The incisions cut through layers of skin, body fat and fascia (connective tissue) until they reach the abdominal muscles. Some incisions avoid the muscles entirely, some split or separate them to avoid them, and some cut through layers of muscle. Examples of different abdominal incisions include:

• Midline. This is the standard laparotomy incision, also described as a ventral laparotomy. It follows the vertical midline of your abdomen close to your belly button. Your surgeon might curve around your belly button, or they might push it aside to keep a straight line. If they only need to access the upper or lower half of your abdomen, they may only cut above or below it.
• Paramedian. A paramedian incision also travels vertically through your abdomen but to one side of the midline. This allows better access to your kidneys and adrenal glands on that side.
• Transverse. A transverse incision is horizontal (lateral) and below your belly button. This is another common approach to laparotomy. It offers wide access to your organs and heals well.
• Pfannenstiel. A Pfannenstiel incision is a low transverse incision, also called a bikini incision. It’s a common approach for a pelvic laparotomy. The cut arcs slightly just over your pubic bones.
• Subcostal. A subcostal incision (Kocher incision) is diagonal on one side of your upper abdomen (your epigastric region). Surgeons use it to access the specific organs in these areas —your spleen in the upper left, or your liver, gallbladder and bile ducts on the right.
• Rooftop. A rooftop incision, also called a chevron, is a subcostal incision on each side that joins at the midline. It allows access to all of your epigastric organs, including organs that pass through the middle of the region and both kidneys or both adrenal glands at the sides.

What happens after the operation?

When you come out of surgery, you’ll transfer to a postoperative room, where healthcare providers will monitor your vital signs until you wake up. Then, they’ll move you to a recovery room for the next few days. The tubes inserted into your body during surgery will remain in place to drain and deliver fluids, and you’ll have pain relief as needed. A healthcare provider will assist you in standing up and walking around a bit each day.

Your provider may give you deep breathing and muscle exercises to do in the hospital and when you return home. These help prevent blood clots and chest infections. Your provider will also instruct you on caring for your incision at home. It’s common for your bowels to be temporarily paralyzed after abdominal surgery (paralytic ileus). Your healthcare provider can give you an enema or medications if necessary to help you poop.

What are the benefits of laparotomy?

Laparotomy helps surgeons diagnose and treat a wide range of conditions, often at the same time. All surgeons can perform a laparotomy, and they can adapt the procedure with different approaches to fit the situation. In general, surgeons only use laparotomy when they need to. It might be necessary for speed or accessibility or because of the serious nature of your condition. When needed, it can be life-saving.

What are the risks of laparotomy?

Possible complications include:

• Unintended injury to nearby organs.
• Excessive bleeding from injured blood vessels.
• Wound infection and delayed healing.
• Areas of permanent numbness due to nerve damage.
• Hernias at the incision site or where the muscle was split.
• Internal scar tissue that may interfere with your organs (abdominal adhesions).
• Bowel obstruction due to abdominal adhesions.

What is the recovery time from a laparotomy?

This can vary, depending on your overall health and stamina and how extensive your operation was. It takes an average of six weeks for the incision to heal. It will leave a long scar across your abdomen, which should fade over time. You may have areas of numbness in your abdomen, due to nerve damage. This should improve over the following months, but sometimes, some numbness remains.

You may return to work after the incision has healed, depending on how physical your job is. You won’t be ready for moderate exercise or lifting for a few months. It takes about two years for your core abdominal strength to return to where it was before the surgery. Regular exercise can help with this, but you’ll need to take it slowly. Your surgeon can give you more specific instructions about exercise.

How long does it take for the laparotomy scar to fade?

Your scar should gradually fade and flatten over the next three to six years, depending on genetics and other factors. You can help by taking good care of your incision while it heals and protecting the scar from UV rays afterward. Your surgeon may suggest topical treatments to help diminish your scar.

When should I call my healthcare provider?

After you go home, call your provider if you notice:

• Bleeding or discharge from your surgery site.
• Your pain doesn’t improve or gets worse.
• You have a fever.
• You can’t poop or pass gas.
• Swelling or pain in one of your legs.
• You develop chest pain or a cough.

A note from Cleveland Clinic

A laparotomy allows your surgeon to see and examine many organs at once, which is important when your condition may affect any or many of them. It also allows them to treat conditions urgently when they find them. It’s not a small matter to have open surgery, but someday, you may need it. When the emergency is over, your healthcare team will help guide you through the long recovery process.