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surgical incision into the abdominal wall; often done to examine abdominal organs

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2014/01/26 20:58:07」(JST)

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A laparotomy is a surgical procedure involving a large incision through the abdominal wall to gain access into the abdominal cavity. It is also known as celiotomy.

Terminology[edit]

In diagnostic laparotomy (most often referred to as an exploratory laparotomy and abbreviated ex-lap), the nature of the disease is unknown, and laparotomy is deemed the best way to identify the cause.

In therapeutic laparotomy, a cause has been identified (e.g. peptic ulcer, colon cancer) and laparotomy is required for its therapy.

Usually, only exploratory laparotomy is considered a stand-alone surgical operation. When a specific operation is already planned, laparotomy is considered merely the first step of the procedure.

Spaces accessed[edit]

Depending on incision placement, laparotomy may give access to any abdominal organ or space, and is the first step in any major diagnostic or therapeutic surgical procedure of these organs, which include:

the digestive tract (the stomach, duodenum, jejunum, ileum and colon)
the liver, pancreas, gallbladder, and spleen
the bladder
the female reproductive organs (the uterus and ovaries)
the retroperitoneum (the kidneys, the aorta, abdominal lymph nodes)
the appendix

Types of incisions[edit]

Main article: Surgical Incisions

Midline[edit]

The most common incision for laparotomy is the midline incision, a vertical incision which follows the linea alba.

The upper midline incision usually extends from the xiphoid process to the umbilicus.

A typical lower midline incision is limited by the umbilicus superiorly and by the pubic symphysis inferiorly.

Sometimes a single incision extending from xiphoid process to pubic symphysis is employed, especially in trauma surgery.

Midline incisions are particularly favoured in diagnostic laparotomy, as they allow wide access to most of the abdominal cavity.

Midline incision[edit]

cut (incised) the skin in mid line (linea alba).
cut (incised) subcutaneous tissue.
divide the linea alba (white line of the abdomen).
pick up peritoneum, confirm that there is no bowel adhesion (intestinal adhesion).
nick peritoneum.
insert finger beneath the wound to make sure that there is no adhesion.
cut the peritoneum with scissors.</ref> operative surgery of ( lsmu )

Other[edit]

Other common laparotomy incisions include:

the Kocher (right subcostal) incision (after Emil Theodor Kocher); appropriate for certain operations on the liver, gallbladder and biliary tract.^[1]^[2] This shares a name with the Kocher incision used for thyroid surgery: a transverse, slightly curved incision about 2 cm above the sternoclavicular joints;

the Davis or Rockey-Davis "muscle-splitting" right lower quadrant incision for appendectomy;

the Pfannenstiel incision, a transverse incision below the umbilicus and just above the pubic symphysis.^[3]^[4] In the classic Pfannenstiel incision, the skin and subcutaneous tissue are incised transversally, but the linea alba is opened vertically. It is the incision of choice for Cesarean section and for abdominal hysterectomy for benign disease. A variation of this incision is the Maylard incision in which the rectus abdominis muscles are sectioned transversally to permit wider access to the pelvis.^[5]

Lumbotomy consists of a lumbar incision which permits access to the kidneys (which are retroperitoneal) without entering the peritoneal cavity. It is typically used only for benign renal lesions. It has also been proposed for surgery of the upper urological tract.^[6]

Cherney Incision

Related procedures[edit]

A related procedure is laparoscopy, where cameras and other instruments are inserted into the peritoneal cavity via small holes in the abdomen. For example, an appendectomy can be done either by a laparotomy or by a laparoscopic approach.

References[edit]

^ synd/1010 at Who Named It?
^ "Incisions". Archived from the original on 2007-11-01. Retrieved 2007-11-22.
^ synd/2500 at Who Named It?
^ H. J. Pfannenstiel. Ueber die Vortheile des suprasymphysären Fascienquerschnitts für die gynäkologischen Koeliotomien. (Volkmann’s) Sammlung klinischer Vorträge, Leipzig, 1900, n F. 268 (Gynäk. Nr. 97), 1735-1756.
^ Giacalone PL, Daures JP, Vignal J, Herisson C, Hedon B, Laffargue F (2002). "Pfannenstiel versus Maylard incision for cesarean delivery: A randomized controlled trial". Obstetrics and gynecology 99 (5 Pt 1): 745–50. doi:10.1016/S0029-7844(02)01957-9. PMID 11978282.
^ Bajpai M, Kumar A, Gupta AK, Pawar DK (2004). "Lumbotomy approach for upper urological tract surgery in children--an analysis of 68 consecutive lumbotomies". European Journal of Pediatric Surgery 14 (3): 163–7. doi:10.1055/s-2004-820903. PMID 15211405.

External links[edit]

Article about exploratory Laparotomy
Article about Abdominal exploratory surgery in animals

UpToDate Contents

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English Journal

Don't Fear Adhesions: Safe Approaches for Reoperative Minimally Invasive Surgery.

Kim RS, Itriago FP, Rosser Jr JC, Redan JA.SourceFellow in Colon and Rectal Surgery, Orlando Health, Colon and Rectal Clinic, Orlando, Florida.
Surgical technology international.Surg Technol Int.2012 Dec 1;XXI:147-155. [Epub ahead of print]
Experience in minimally invasive surgery has increased at a rapid pace, and previous abdominal surgery with adhesion formation is no longer considered a contraindication for laparoscopic surgery. Therefore, surgeons across all specialties should be well equipped to approach a reoperative abdomen wit
PMID 22504984

Impact of single-dose application of TGF-β, copper peptide, stanozolol and ascorbic acid in hydrogel on midline laparatomy wound healing in a diabetic mouse model.

Konerding MA, Ziebart T, Wolloscheck T, Wellmann A, Ackermann M.SourceInstitute of Functional and Clinical Anatomy, University Medical Center of the Johannes Gutenberg University Mainz, D-55126 Mainz, Germany.
International journal of molecular medicine.Int J Mol Med.2012 Aug;30(2):271-6. doi: 10.3892/ijmm.2012.1005. Epub 2012 May 18.
Despite numerous advances and improvements in surgical techniques the incidence of incisional hernias after laparotomy remains high. The aim of this study was to investigate possible effects of single application of ascorbic acid, stanozolol, a synthetic anabolic
PMID 22614259

Japanese Journal

CTで術前診断し得た子宮広間膜裂孔ヘルニアの1例

柴田健一,小野寺雄二,萩原資久,陳正浩,橋爪英二,鈴木晃,木村理
山形大学紀要. 医学 : 山形医学 32(2), 77-80, 2014-08-15
腹部のイレウスの原因に内ヘルニアがあるが、術前に診断することは難しい。今回、われわれは、比較的まれな疾患である子宮広間膜裂孔ヘルニアをCTで術前診断して、手術を行った1例を経験したので報告する。症例は59歳、女性。下腹部痛を主訴に外来を受診した。腹部CT検査で、骨盤内に限局した小腸のループ形成がみられた。子宮と直腸を右側に圧排しており,子宮広間膜裂孔ヘルニアと診断した。外科に入院となり、緊急手術を …
NAID 110009825048