EXPLORATORY LAPAROTOMY 

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An exploratory laparotomy is a surgical procedure where a large incision is made in the abdomen to allow a surgeon to visually examine and investigate the organs inside the abdominal cavity. 

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During the procedure, the patient is put under general anesthesia. The surgeon then makes an incision, usually in the midline of the abdomen, to access the abdominal organs. The stomach, liver, gallbladder, spleen, pancreas, kidneys, intestines, and reproductive organs can all be checked for signs of disease, injury, or abnormality.

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The procedure may allow for immediate treatment of any problems that are discovered. For example, if a tumor is found, it may be removed during the same operation. If a definitive diagnosis cannot be made during the surgery, the surgeon may take a biopsy of tissue for further examination.

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Postoperatively, patients usually need to stay in the hospital for several days for monitoring and recovery.

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With the advancements in minimally invasive procedures such as laparoscopy and imaging technologies, the need for exploratory laparotomy has decreased, but it's still considered an important tool when other diagnostic methods fail or in emergency situations.

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                                                                     Anesthetic Implications for Exp Lap

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Anesthesia type: General, combined epidural and general anesthesia

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Airway: Endotracheal tube

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Preoperative:

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• Patients with perforation, peritonitis, and obstruction are likely to need emergency laparotomy

• High risk for the pulmonary aspiration of gastric contents

• Patients with gastrointestinal stasis should be considered full stomach precautions

• Consider the availability of rapid infusion device

• Consider the placement of an arterial line 

• Two large-bore peripheral intravenous (IV) lines are preferred

• Previous chemotherapy may be associated with anemia, renal, hepatic, pulmonary toxicity, and cardiomyopathy

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Intraoperative:

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• Potential for significant fluid shifts and blood loss

• Warm fluids

• Prevent hypothermia during long operations

• Duration: 1-4 hours

• Position: Supine with arms out

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Postoperative:

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• ​Pain management

• Epidural

• PCA

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Complications:

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• Bleeding

• Infection

• Atelectasis

• Pneumonia

• Venous thromboembolism (VTE)

• PONV

• Pulmonary function is impaired after abdominal surgery 

• Injury to abdominal organs

• Formation of adhesions

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Sources:

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Macksey, L. F. (2011). Surgical procedures and anesthetic implications: A handbook for nurse anesthesia practice. 

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Jaffe, R. A. (2020). Anesthesiologist's Manual of Surgical Procedures (6th ed.). 

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Singh-Radcliff, N. (2013). 5-Minute Anesthesia Consult.

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