Middle laparotomy is a rather complicated operation that requires a specialist to have deep knowledge of anatomy, as well as skills in using surgical instruments. In addition, this procedure requires some preparation of the patient.
What is the procedure?
Middle laparotomy, the photo of which clearly demonstrates the peculiarity of the operation, is a surgical procedure performed through an incision on the anterior wall of the abdominal cavity. The method of incision largely depends on the extent of the surgical intervention and the area where the operation will be performed.
In addition, with the help of this operation, it is possible to carry out diagnostics in order to identify pathologies that cannot be detected in any other way.
Features of the operation
Middle laparotomy should be performed subject to certain principles of intervention:
- with minimal trauma;
- without touching large blood vessels;
- bypassing the nerve endings.
At the end of the required manipulations, the tissues must be sewn up in such a way that the seam does not open, the internal organs are not deformed. The operation is carried out in the presence of variousinjuries and oncological diseases.
Types of laparotomy
In surgical practice, a variety of types of operations are used, namely:
- median laparotomy;
- lower median laparotomy;
- lower laparotomy.
It is often the middle operation that is used. In this case, the incision is made along the midline of the abdomen.
Laparotomy for diagnosis
Diagnostic laparotomy is used quite rarely, mainly for injuries of the abdominal organs, acute surgical diseases that cannot be detected by other research methods. Basically this diagnostic method is applied:
- in the presence of an injury to the stomach, pancreas, kidneys;
- peptic ulcer;
- malignant tumors;
- necrosis;
- internal hernia;
- peritonitis.
This operation requires preliminary comprehensive preparation, during which specialists determine the progress of work in advance, assess existing risks and take measures to eliminate them. The duration of the procedure is no more than 2 hours, and in case of heavy bleeding no more than 20-30 minutes.
Indications for surgery
The main indications for midline laparotomy are:
- ruptured ovarian cyst;
- tubal infertility;
- ectopic pregnancy;
- ovarian cyst;
- purulent inflammation of the fallopian tubes or ovary;
- inflammation of the peritoneum.
In addition, various kinds of tumors of the internal reproductive organs can be a problem.
Rules
Surgical manipulations have many varieties, depending on the disease, which is an indication for surgery, the anatomical features of the patient, as well as many other factors. There are such methods:
- longitudinal;
- oblique;
- transverse;
- angular;
- mixed.
Regardless of the type of incision, a number of rules must be observed during the operation. The correct position of the patient on the couch is important. For example, when performing a median laparotomy, the patient should lie on his back. For upper midline surgery, a bolster should be placed under the lower back to slightly elevate the area to be operated on. It is important to avoid injury to nerve fibers.
To prevent infection of the incision, as well as severe bleeding, the edges should be covered with sterile wipes and swabs. To prevent the formation of adhesions, saline should be used. After performing the abdominal surgery, the surgeon assesses the degree of the pathological process and its spread, bleeding is eliminated and the lymph nodes are examined.
Preparing for the procedure
Preparation for the operation has almost no features. The patient is taking blood for analysis:
- general;
- biochemical;
- for sugar.
In addition, you need to determine the blood type and Rh factor, take blood and urine tests to determine various infections. Depending on the reason for the operation, it is necessary to initially do an ultrasound examination of the diseased organ. In connection with the anatomical features of the course of the pathological process, the method of performing laparotomy is selected.
The day before the operation, you can not eat or drink a lot of liquid. Depending on the blood type and the characteristics of the course of the disease, the resuscitator selects the type of anesthesia. If the disease has become acute and emergency intervention is required, then the preparation is minimized to two hours.
Surgery technique
The median laparotomy technique refers to the longitudinal one. It can be lower, upper or middle. Lower median laparotomy is not performed very often, only in cases where extensive access to the diseased organ is required, and also as a result of:
- fixed tumor;
- abdominal revision;
- extended uterine intervention.
The incision is made in the lower abdomen, vertically in the middle, and allows access to the internal genital and other organs located in this area. If necessary, the incision can be additionally drawn up, bypassing the liver and navel. The lower laparotomy is performed with a pen-operated scalpel from the bottom up. The incision is made in layers so as not to injure the intestines and many others.internal organs. The length of the incision is determined according to the proposed surgical intervention, but it should not be too large or small. The edges of the incision are moved apart with special clamps, then the operation is performed. When performing a lower median laparotomy, the incision can be not only vertical, but also transverse, for example, with a caesarean section. In this case, an incision is made in the lower abdomen, cutting it across, above the pubic bone. During surgery, the vessels are cauterized by coagulation. A transverse laparotomy has a much shorter postoperative period than a longitudinal one, since it is less traumatic for the intestines and the suture will be less noticeable.
Upper median laparotomy is characterized by the fact that a vertical incision is made in the middle of the abdomen, only it starts in the intercostal space and stretches down, but does not reach the navel. This type of operation has a number of advantages, as it provides the fastest penetration to the abdominal organs located in its upper part. This is important if the slightest delay will cost the patient his life, as well as with extensive internal bleeding or damage to several organs at once. If necessary, the incision can be extended down.
Medium median laparotomy has certain disadvantages. For example, when using this technique, the upper and lower sections of muscle tissue can be very severely injured. When scarring, muscle fibers experience a very strong tension, which threatens to form a hernia. In addition, fabrics are very longheal due to the significant depth of the suture and poor blood supply to this area.
Steps of operation
Initially, the skin is cut along with the subcutaneous tissue. After the incision is made, the wound must be dried and the bleeding vessels must be seized with special clamps. Using napkins, the surgeon isolates the surgical wound from the skin.
After that, the doctor cuts the peritoneum with special scissors. The edges of the abdominal cavity are parted, and the internal organs are examined in order to identify and eliminate pathological processes. After the operation, a drainage is installed, which is fixed to the skin with a silk thread. The suture is initially applied to the peritoneum, and then the skin is sutured. After the laparotomy, the abdomen is carefully treated with an antiseptic.
Post-operative period
After a median laparotomy, the patient must be under the supervision of doctors in the hospital for at least a week. Since this operation is abdominal and rather complicated, it is important to prevent the risk of complications, in particular:
- internal bleeding;
- wound infection;
- impaired functioning of internal organs.
In the first days after the operation, patients may experience severe pain, so analgesics are used in the form of injections. If the temperature rises, antibiotics may be prescribed.
Stitches are usually removed on the seventh day, but with slow healing or in case of repeated surgery, this period may beextended to two weeks. After discharge from the hospital, rehabilitation is carried out on an outpatient basis, but it is necessary to undergo regular examinations. Sports after median laparotomy are contraindicated for several months. It is especially not recommended to exercise the abdominal muscles and lift weights.
In the process of rehabilitation, it is worth sticking to a he althy diet, do not overeat, as the operation may adversely affect the functioning of the intestines. The doctor determines all other contraindications individually for each patient, depending on the initial disease.
Contraindications and complications
Laparotomy, which is performed urgently, has absolutely no contraindications. Elective surgeries necessarily require 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 operation area;
- suppuration of the wound;
- vascular damage;
- damage to nearby organs;
- Adhesion formation.
As there are certain contraindications for surgery, alternative treatments can be found.
