Overview
Exploratory Laparotomy is a surgical procedure used to explore the abdominal cavity for diagnostic or therapeutic purposes. It is essential for trauma, acute abdomen, and diagnostic dilemmas.
Exploratory laparotomy is crucial for diagnosing and treating acute abdominal conditions, trauma, and surgical emergencies. It provides direct visualization and access to all abdominal organs.
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Indications
Blunt or penetrating abdominal trauma
Unexplained abdominal pain
Generalized peritoneal inflammation
Mechanical obstruction
Shock with abdominal findings
Contraindications
Absolute Contraindications
Relative Contraindications
📋 Equipment Checklist
Check off items as you gather them:
Pre-procedure Preparation
Preparation includes patient consent, preoperative antibiotics, positioning, equipment setup, and team briefing. All team members should understand their roles.Step-by-Step Procedure
Step 1: Patient Preparation
Position patient, prep and drape, administer antibiotics.
⚠️ Common Mistakes to Avoid:
- Poor positioning
- Inadequate prep
- Missed antibiotics
💡 Pro Tip:
Position patient supine with arms abducted.
Step 2: Incision
Make midline incision from xiphoid to pubis.
⚠️ Common Mistakes to Avoid:
- Wrong incision
- Too small incision
💡 Pro Tip:
Use midline incision for optimal exposure.
Step 3: Exploration
Systematically explore all quadrants and organs.
⚠️ Common Mistakes to Avoid:
- Incomplete exploration
- Missed pathology
💡 Pro Tip:
Follow systematic approach to exploration.
Step 4: Diagnosis
Identify pathology and plan treatment.
⚠️ Common Mistakes to Avoid:
- Wrong diagnosis
- Missed pathology
💡 Pro Tip:
Document all findings carefully.
Step 5: Treatment
Perform necessary surgical procedures.
⚠️ Common Mistakes to Avoid:
- Inadequate treatment
- Complications
💡 Pro Tip:
Address all identified pathology.
Step 6: Closure
Close abdomen in layers, apply dressing.
⚠️ Common Mistakes to Avoid:
- Poor closure
- Wound dehiscence
💡 Pro Tip:
Close fascia and skin properly.
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Post-procedure Care
Post-procedure care involves monitoring for complications, wound care, pain management, and rehabilitation.Complications & Management
| Complication | Incidence | Signs | Management | Prevention |
|---|---|---|---|---|
| Bleeding | 5-10% | Hemodynamic instability | Exploration, hemostasis | Careful dissection |
| Infection | 10-20% | Fever, wound erythema | Antibiotics, drainage | Preoperative antibiotics |
| Wound dehiscence | 5-10% | Wound separation | Wound care, reclosure | Proper closure technique |
| Adhesions | 20-30% | Bowel obstruction | Surgical lysis | Gentle handling |
Clinical Pearls
Use midline incision for optimal exposure.
Follow systematic approach to exploration.
Document all findings carefully.
Address all identified pathology.
Close fascia and skin properly.
Monitor for complications post-operatively.
Gentle handling prevents adhesions.