Laparotomy (abdominal incision) is an autopsy of the abdominal cavity. It is performed during operations on the abdominal organs. Diagnostic, or trial, laparotomy is performed to clarify the nature of the disease. Preparation for laparotomy begins on the eve or in a few days depending on the intended operation. The patient receives a bath, his hair is shaved in the area of the surgical field, the intestines are cleaned with an enema. The presence of pustules, eczema, even on parts of the skin distant from the abdominal wall, is a contraindication to a planned laparotomy. Elderly and weakened patients need special preoperative preparation aimed at improving the function of the respiratory and cardiovascular systems. For this, the patient is taught to deep and even breathing, inject drugs that stimulate heart activity and improve blood circulation .
Exhausted and dehydrated patients are prescribed intravenous fluids (glucose, saline solutions, blood), vitamins, etc. Laparotomy is performed under local anesthesia or anesthesia. In the latter case, the additional introduction of muscle relaxants , well relaxing the abdominal wall. The skin of the abdominal wall is treated with alcohol and iodine tincture. The nature of the incision depends on the location of the affected organ (Fig.). For example, in appendicitis, an oblique incision is used in the right iliac region (see Appendectomy ), for stomach surgery, an incision is made along the midline of the abdomen from the xiphoid process to the navel , etc. white line, preperitoneal tissue, peritoneum; during surgery for appendicitis, cut through the skin, subcutaneous tissue, aponeurosis of the external oblique muscle, pushing the fibers of the internal oblique and transverse muscles, dissect the preperitoneal tissue, peritoneum.Go
After the end of the operation, you should make sure that there is no bleeding. In order to avoid leaving foreign bodies in the abdominal cavity (napkins, instruments, etc.), the ends of large napkins are attached with clips to surgical clothes, and small napkins and balls are strengthened in the clips. The operating sister produces an account of the napkins and instruments before and after the operation. The wound is sutured in layers. The peritoneum and muscles are sutured with catgut, the aponeurosis, and the skin with silk threads. In the postoperative period, apply morphine, pantopon , promedol , antibiotics ( penicillin , streptomycin , neomycin, etc.), saline solutions intravenously, prescribe banks, mustard plasters, exercise therapy . In case of nausea and vomiting, a continuous suction of the gastric contents with a three-canal or water jet suction is performed. The first cleansing enema is placed on the 3-4th day. It is necessary to monitor the condition of the surgical wound and, at the first signs of suppuration, remove 1-2 sutures and apply a bandage (sticker) with 10% sodium chloride solution.
The most commonly used sections of the abdominal wall are:
1 - on the white line of the abdomen above and below the navel; 2 - oblique.