Exploratory Laparotomy: What to Expect on the Day of Surgery

An exploratory laparotomy—also called an "ex lap" or celiotomy— is a major surgery that involves making a large incision in the abdomen in order to diagnose and potentially treat serious medical conditions, such as ovarian cancer, a perforated bowel, or internal bleeding from a significant abdominal injury.

An exploratory laparotomy is usually performed by a general surgeon, trauma surgeon, or surgeon who specializes in treating gynecological cancers.

Patient undergoing laparotomy
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Before the Surgery

On the actual day of your surgery, you will arrive at the hospital and be directed to a pre-operative room.

In the pre-operative room, you can expect the following:

  • You will change into a hospital gown and place your personal items and clothes in a locker or give them to a loved one in the family waiting room.
  • A nurse will record your vitals and place an IV into your vein for administering fluids and medications during the surgery.
  • Your surgeon and a doctor who administers general anesthesia (called an anesthesiologist) will come to greet you. They will briefly re-review the surgery. You may need to sign an additional consent form at this time.

When the surgical team is ready, you will be taken into the operating room. The anesthesiologist will administer various drugs. These medications will cause you to temporarily lose consciousness so you experience no awareness or pain during the operation.

Emergent Exploratory Laparotomy

If the surgery is performed emergently, the preparation process moves much faster. It requires a delicate balance of administering life-saving therapies, like fluid and blood products, while also moving the patient into the operating room to begin the surgery as quickly as possible.

During the Surgery

Once you are in the operating room and are asleep, a member of the surgical team will place a urinary catheter. The anesthesiologist will then insert an endotracheal tube into your airway to control your breathing.

During the remainder of the surgery, the anesthesiologist will stay in the operating room to monitor your blood oxygen level and vitals (e.g., heart rate and blood pressure).

Once you are asleep in the operating room, the surgery will proceed with the following steps:

  • The skin of your abdomen will be cleaned with an antiseptic solution to help prevent infection.
  • The surgeon will make an incision (a large cut) within the abdomen—most commonly, the incision is made vertically down the middle of the abdomen.
  • The abdominal and pelvic organs and tissues (e.g., small intestines, appendix, gallbladder, abdominal lymph nodes) will be examined for signs of inflammation, infection, and damage.
  • Once the surgeon has found the source of your symptoms or injury, a therapeutic procedure may be performed. For example, the surgeon may repair a perforated bowel or drain an intrabdominal abscess.
  • If cancer is suspected, a biopsy may be taken for diagnosis or staging purposes. A "washing" may also be performed in which sterile fluid is injected into the abdominal cavity. While you are still in the operating room, these tissue and fluid samples may be examined by a doctor called a pathologist. If cancer cells are present, the surgeon may proceed with removing the affected organ(s).
  • After the surgery is completed, the surgeon will close the incision site, usually with sutures or staples. In some instances, one or more drains may be placed near the incision site. The incision site will then be covered with a bandage.
  • Once the incision is closed, the anesthesia medicine will be stopped, the breathing tube will be removed, and you will be taken to a recovery room.

The overall duration of the operation is highly variable. The timing depends largely on why the surgery is being performed in the first place and what is found during the surgeon's exploration.

Minimally Invasive Approach

It's important to keep in mind that while an exploratory laparotomy is traditionally an open surgery, the surgery may be performed laparoscopically.

Exploratory laparoscopic surgery is a minimally invasive procedure in which the surgeon makes multiple tiny incisions in the abdomen instead of one large incision. Through these tiny incisions, an instrument with a camera attached to it (called a laparoscope), as well as other long, thin surgical instruments, are inserted and used to perform the surgery.

Undergoing an open versus laparoscope approach typically depends on the surgeon's discretion and the case at hand.

Open surgery is nearly always used in the following situations:

  • Emergency situations, like if a patient experiences a penetrating injury (e.g., a stabbing) or a blunt force trauma from a car accident
  • If the surgeon needs to visualize multiple organs or a large portion of a single organ, like the intestines

After the Surgery

When you wake up in the recovery room, you may experience pain, nausea, vomiting, and grogginess. A nurse will be present to help alleviate these symptoms with various medications. Your nurse will also carefully monitor your vital signs, including your heart rate, blood pressure, and temperature.

Once your vitals are stable and your pain is under control, you will be taken to a hospital room (either a regular room or a room in the surgery intensive care unit).

Here you will stay for approximately five to 10 days, depending on the extent of the surgery. Longer stays are often required for patients who underwent an emergent exploratory laparotomy as a result of major trauma.

Once you have been taken to your hospital room, you can expect the following:

  • You will continue to be given pain medication (an opioid) through your IV; eventually, the medication will be transitioned over to an oral drug.
  • You will be given a stool softener to prevent constipation (this is common after surgery and when taking an opioid).
  • You may be given an antibiotic to prevent infection.
  • You will be able to begin eating when your bowels start functioning normally (usually in a few days).
  • You will be given a blood thinner or compression boots to help prevent blood clots in your legs.
  • You will be given a breathing exercise device called an incentive spirometer to help prevent pneumonia.
  • A physical therapist may visit you in your room to help you start moving about and walking around.
  • Your urinary catheter and abdominal drain (if placed) will typically be removed within a few days of being in the hospital and prior to discharge.

A Word From Verywell

In summary, an exploratory laparotomy is exactly what it sounds like—it's a procedure in which a surgeon explores a patient's abdominal cavity in order to diagnose (and potentially treat) a medical pathology that either requires emergent attention or cannot otherwise be diagnosed through less-invasive methods.

If you (or a loved one) have undergone this major surgery, please do not hesitate to reach out to your surgical team with any questions or concerns during your recovery and healing process.

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