Purpose of Exploratory Laparotomy

Exploratory laparotomy, also known as a celiotomy or "ex lap," is performed by a general or trauma surgeon in a hospital under general anesthesia. The surgery involves making a large abdominal incision in order to "explore" the abdominal cavity and potentially treat (during the same operation) various abdominal pathologies.

Diagnoses Related to Exploratory Laparotomy

The purpose of an exploratory laparotomy is to examine abdominal and pelvic organs and tissues. While this operation is most commonly performed emergently in trauma situations, it may also be used to determine the source of a patient's abdominal or pelvic pain.

During an exploratory laparotomy, the organs and tissues that can be inspected for bleeding, disease, damage, or abnormal growths, include:

Diagnoses that may result from the visual inspection of the above organs include:

• Peritonitis
• An obstruction or perforation (hole) in the stomach or intestines
• Intussusception
• Appendicitis
• Scar tissue in the abdomen (called adhesions)
• Gallbladder disease
• Liver disease, infection, or injury
• Pancreatitis
• Abdominal abscess
• Intestinal ischemia
• Diverticulitis
• Bleeding in the peritoneal cavity (called hemoperitoneum)
• Endometriosis
• Ectopic pregnancy

Certain cancers—ovarian, colon, liver, and pancreatic—may also be diagnosed during an exploratory laparotomy. This often requires that the surgeon takes a tissue biopsy during the surgery. Moreover, for certain cancers, like ovarian cancer, staging of the cancer may be performed during the same operation.

Criteria

There is no formal criteria that a patient needs to meet in order to undergo an exploratory laparotomy. That said, certain patients may not be suitable candidates, such as those with widespread metastatic cancer or sepsis.

Additionally, it's important to mention that an exploratory laparotomy, which is an open surgery, has largely been replaced with laparoscopic surgery.

During an exploratory laparoscopy, instead of one large incision, the surgeon makes multiple small incisions in a patient's abdomen. The surgeon then inserts various surgical instruments (one of which has a tiny camera attached to it), in order to inspect the abdominal cavity.

The benefits of the laparoscopic approach over the open approach are that patients experience:

• A reduced hospital stay
• Less pain after surgery
• Less scarring on the abdomen

That said, exploratory laparotomy remains the surgery of choice in select cases. For example, if a patient experiences blunt abdominal trauma (e.g., from a car accident) or a penetrating abdominal trauma (e.g., a stabbing or gunshot wound), a traditional laparotomy versus a laparoscopy if often warranted.

This is because only by opening up a large portion of the patient's abdominal cavity can the surgeon locate the source of bleeding and stop it.

Besides trauma situations, other instances that call for the laparotomy approach include:

• When the patient is medically unstable.
• When a large part of an organ needs to be examined and accessed.
• When multiple organs/tissues need to be removed (for example, the Whipple procedure for pancreatic cancer.
• When a patient has obscure bleeding in their digestive system that cannot be controlled endoscopically or by embolization (blockage) of the bleeding artery.
• When a patient has a history of multiple abdominal operations, and as a result, likely has adhesions.

Tests and Labs

Typically, one or more imaging tests are performed to determine if an exploratory laparotomy is needed in the first place.

These imaging tests of the abdomen may include:

• An ultrasound
• A computed tomography (CT) scan
• A magnetic resonance imaging (MRI) test

Then, if an exploratory laparotomy is deemed necessary, various tests may be ordered to ensure the patient is safe for general anesthesia.

These tests may include:

• Electrocardiogram (ECG)
• Laboratory tests (e.g., complete blood count, comprehensive metabolic panel, and a coagulation panel)

A Word From Verywell

There are a number of different reasons why an exploratory laparotomy may be performed. Whether you are undergoing this operation because you underwent a traumatic abdominal injury or because the source of your abdominal pain cannot be found through less-invasive methods, it's normal to feel apprehensive beforehand.

Try to remain calm, reach out to others for support, and if possible (the operation is not emergent), share any concerns you have with your surgeon beforehand.