49000 Exploratory laparotomy, exploratory celiotomy with or without biopsy(s) (separate procedure)

Name of the Procedure:

Exploratory Laparotomy, Exploratory Celiotomy with or without Biopsy(s) (Separate Procedure)

Summary

An exploratory laparotomy, also known as exploratory celiotomy, is a surgical procedure where an incision is made in the abdominal wall to allow the surgeon to look inside the abdominal cavity. This procedure may include biopsies, which involve taking small tissue samples for further examination.

Purpose

The primary purpose of an exploratory laparotomy is to diagnose and, at times, treat conditions within the abdomen that are not identifiable through non-invasive methods. The goals include identifying the cause of abdominal pain, diagnosing conditions like tumors, blockages, or infections, and obtaining tissue samples for biopsy.

Indications

• Unexplained abdominal pain
• Abdominal masses or tumors suspected from imaging
• Symptoms suggesting internal bleeding or infection
• Diagnosis and staging of cancers
• Investigating trauma to the abdomen

Preparation

• Patients are generally instructed to fast for at least 8 hours before the procedure.
• Medication adjustments may be necessary; some blood thinners may need to be paused.
• Pre-procedure diagnostic tests, such as blood work, imaging studies (CT or MRI scans), and EKG, may be required.

Procedure Description

1. The patient is placed under general anesthesia.
2. An incision is made in the abdominal wall to access the abdominal cavity.
3. The surgeon carefully examines the internal organs for abnormalities.
4. If necessary, tissue samples (biopsies) are taken for pathology.
5. Any visualized pathology may be addressed, if feasible, during the same procedure.
6. The incision is closed with sutures or staples.

Tools and equipment include a scalpel, retractors, surgical scissors, forceps, and suction devices. General anesthesia ensures the patient is asleep and pain-free during the procedure.

Duration

The procedure typically takes between 1 to 2 hours, depending on the complexity of the findings.

Setting

Exploratory laparotomy is performed in a hospital operating room.

Personnel

• Surgeon
• Anesthesiologist
• Surgical nurses
• Surgical technologist

Risks and Complications

• Common risks: Infection, bleeding, blood clots, and reactions to anesthesia.
• Rare risks: Injury to internal organs, bowel obstruction, or prolonged ileus (intestinal paralysis).

Benefits

The primary benefit is the definitive diagnosis of abdominal conditions, which can lead to appropriate and targeted treatments. This can provide relief from symptoms and improve the overall health outlook.

Recovery

• Patients will initially stay in the recovery room for monitoring.
• Hospital stay usually ranges from 3 to 7 days, depending on the findings and any additional treatments performed.
• Post-procedure instructions include wound care, activity restrictions, and follow-up appointments.
• Full recovery might take several weeks, during which heavy lifting and strenuous activities should be avoided.

Alternatives

• Non-invasive imaging tests (CT scan, MRI)

• Diagnostic laparoscopy (minimally invasive alternative)

  Pros of alternatives: Less invasive, quicker recovery. Cons of alternatives: May not provide as definitive a diagnosis, limited therapeutic intervention capability.

Patient Experience

• Patients will be under general anesthesia during the procedure, so they will not feel anything.
• Post-operative pain and discomfort are expected, usually managed with pain medications.
• Gradual return to normal diet and activities under medical guidance.