Description of the technique of median laparotomy
Median laparotomy is a rather complicated operation, requiring the specialist to have a profound knowledge of anatomy, as well as skills in possession of surgical instruments. In addition, this procedure requires some preparation of the patient.
What is the procedure?
Median laparotomy, whose photo clearly demonstrates the peculiarity of the operation, is a surgical procedure performed through a cut on the anterior wall of the abdominal cavity. The method of cutting largely depends on the volume of surgical intervention and the area where the operation will be performed.
In addition, this operation can be used to diagnose pathologies that can not be detected in any other way.
Features of operation
Median laparotomy should be performed while observing certain principles of intervention:
- with minimal trauma;
- without touching large blood vessels;
- bypassing the nerve endings.
At the end of the required manipulation, the fabric should be sewn in such a way that the seam does not separate, the internal organs do not deform. The operation is performed in the presence of various injuries and cancer.
Types of laparotomy
In the surgical practice, a wide variety of operations are used, namely:
- mid laparotomy;
- is a lower-end laparotomy;
- lower laparotomy.
The middle operation is often used. In this case, the incision is made along the midline of the abdomen.
Laparotomy for diagnosis
Diagnostic laparotomy is used quite rarely, mainly with abdominal injuries, acute surgical diseases, which can not be detected by other methods of research. Basically, this diagnostic method is used:
- in the presence of a trauma to the stomach, pancreas, kidney;
- peptic ulcer disease;
- malignant tumors;
- internal hernia;
This operation requires preliminary complex preparation, during which the specialists determine the progress of the work in advance, assess the existing risks and take measures to eliminate them. The duration of the procedure is no more than 2 hours, and with severe bleeding no more than 20-30 minutes.
Indications for operation
The main indications for conducting a mid-laparotomy are:
- rupture of the ovarian cyst;
- tubal infertility;
- ectopic pregnancy;
- of the ovarian cyst;
- purulent inflammation of the fallopian tubes or ovary;
- Inflammation of the peritoneum.
In addition, a problem can be various kinds of tumors of internal reproductive organs.
Surgical manipulations have many variations, depending on the disease, which is an indication for the operation, anatomical features of the patient, and many other factors. There are such methods:
Regardless of the type of cut, a number of rules must be followed when performing the operation. The correct location of the patient on the couch is important. For example, in the mid-laparotomy, the patient should lie on his back. In the upper-median operation under the loin should be located a roller to slightly raise the operated area. It is important to avoid traumatization of nerve fibers.
To prevent infection of the incision, as well as severe bleeding, the edges should be covered with sterile napkins and tampons. To prevent the formation of adhesions, saline should be used. After performing abdominal surgery, the surgeon assesses the extent of the pathological process and its distribution, eliminates bleeding and examines the lymph nodes.
Preparing for theprocedure
The preparation for the operation does not have any practical features. The patient is sampled for analysis:
- for sugar.
In addition, you need to determine the blood group and the Rh factor, to pass blood and urine tests to determine various infections. Depending on the reason for the operation, you must first make an ultrasound examination of the diseased organ. In connection with the anatomical features of the course of the pathological process, a technique for performing laparotomy is selected.
One day before the operation, you can not eat and drink plenty of fluids. Depending on the blood group and the features of the course of the disease, the resuscitator selects the type of anesthesia. If the disease has become acute and emergency intervention is required, the preparation is minimized up to two hours.
Technique for performing
The technique of median laparotomy refers to the longitudinal technique. It can be lower, upper or middle. The lower middle laparotomy is not performed very often, only in those cases when extensive access to the diseased organ is required, as well as as a result of:
- of a fixed tumor;
- revision of abdominal cavity;
- enhanced interventions on the uterus.
The incision is performed in the lower abdomen, vertically in the middle, and allows access to internal sex and other organs located in this area. If necessary, the incision can additionally be carried up, bypassing the liver and navel. Lower laparotomy is carried out with a penile scalpel from the bottom up. The cut is performed layer by layer so as not to injure the intestines and many other internal organs. The length of the incision is determined according to the proposed surgical procedure, but it should not be too large or small. The edges of the incision are moved apart by special clamps, then the operation is performed. When carrying out the lower-median laparotomy, the incision can be not only vertical, but also transverse, for example, at a caesarean section. In this case, the incision is made in the lower abdomen, cutting it across, over the pubic bone. In the course of surgical intervention, the vessels are cauterized by coagulation. The transverse laparotomy has a much smaller postoperative period than the longitudinal one, as it is less traumatic for the intestine and the seam will be less noticeable.
The upper median laparotomy is characterized by a vertical incision in the middle of the abdomen, only it starts in the intercostal space and extends downward, but does not reach the navel. This type of operation has a number of advantages, as it provides the fastest penetration to the organs of the abdominal cavity located in its upper part. This is important if the slightest delay will cost the patient life, as well as with extensive internal bleeding or damage to several organs at once. If necessary, the cut can be extended downward.
The average median laparotomy has certain drawbacks. For example, with the application of this technique, the upper and lower parts of the muscle tissue can be severely injured. When scarring, the muscle fibers experience a very strong tension, which threatens the formation of a hernia. In addition, the tissues heal for a very long time because of the considerable depth of the seam and the poor blood supply of this area.
Stages of operation
Initially, the skin is cut along with the subcutaneous tissue. After the cut is completed, the wound needs to be drained and the bleeding vessels seized with special clamps. With the help of napkins, the surgeon isolates the surgical wound from the skin.
After this, the doctor conducts the dissection of the peritoneum with special scissors. The edges of the abdominal cavity are bred, and internal organs are examined for the purpose of determining and eliminating pathological processes. After the operation, drainage is installed, which is fixed to the skin with a silk thread. The seam is imposed initially on the peritoneum, and then the skin is sewn up. After the laparotomy, the stomach is carefully treated with an antiseptic.
After a mid-term laparotomy, the patient should be under the supervision of doctors in the hospital for at least a week. Since this operation is cavitary and complicated enough, it is important to prevent the risk of complications, in particular:
- internal bleeding;
- infection of a wound;
- dysfunction of internal organs.
In the first days after the operation, patients can experience severe pain, so analgesics are applied in the form of injections. With an increase in temperature, antibiotics can be prescribed.
Sutures are usually removed on the seventh day, but with slow healing or in the case of a second operation this period can be extended to two weeks. After discharge from the hospital, rehabilitation is carried out on an outpatient basis, but regular check-ups are necessary. Sport after mid-laparotomy is contraindicated for several months. It is especially not recommended to do loads on the abdominal muscles and lift weights.
In the process of rehabilitation it is necessary to adhere to a healthy diet, not to overeat, as the operation can negatively affect the functioning of the intestine. All other contraindications doctor determines individually for each patient, depending on the initial disease.
Contraindications and complications
Laparotomy, which is performed urgently, has absolutely no contraindications. Planned operations necessarily require the preliminary treatment of inflammatory processes, which can provoke a variety of complications in the postoperative period.
Laparotomy can be complicated by a variety of pathological conditions, namely:
- bleeding in the area of surgery;
- suppuration of wound;
- vascular injury;
- damage to a number of located organs;
- adhesion formation.
Because there are certain contraindications for the operation, alternative therapies can be selected.