Laparotomy – opening and closing

Mr Maheshwar Naidoo

FCS(SA)

Ngwelezana Hospital

South Africa

Watch Video

• 8 minutes

• VTS_03_1.VOB (“How to Operate”)

• Reading material • Farqharsons 10th Ed, Chapter 13, pages 209-225

• Scott-Conner and Dawson, 4th Ed, Chapter 44, Pages 246 -255

• SRB’s surgical operations: Text and Atlas, Chapter 3, Pages 34 - 67

• How to Operate - For MRCS Candidates and Other Surgical Trainees DVD (3 DVD Set)

How many different laparotomy incisions are there?

• A= Vertical midline • B= paramedian• C= gridiron• D= Lanz / Rockey Davis• E= Pfannenstiel• F= Suprapubic• G= Transverse upper abdominal• H= Subcostal (Kocher incision)• I= Oblique iliac muscle cutting incision• J = Chevron / Rooftop/ bilateral subcostal incision

LAPAROTOMY IS A MISNOMER. Correct technical term is a celiotomy.

J

Position of patient Name of this position?

Lithotomy?

Lloyd DavisFor laparotomy • Supine• Position of patient’s upper limbs?• Foley catheter?• NGT?• DVT prophylaxis?• NO contact between patient’s skin and any metal object• Pressure necrosis prevention• Avoid leaning on the patient• Ergonomic position and posture of surgeon

Midline laparotomy incision – layer by layer

L

• External oblique• Internal oblique• Transversalis muscle

Linea alba

Sheath layers above umbilicus

Sheath layers below umbilicus

Cleaning and draping/ operative tray

Exploratory laparotomy

Abdominal closure

• As per video but use toothed Bonney/ Ramsey forceps rather than hands

• Skin – reserve skin clips for SSG

Review in SOPD

ROS as local clinic

Open abdomen =LAPAROSTOMY

Complication of a “Bogota Bag”

End

questions