Now that so much abdominal surgery can be done by laparoscopy, using instruments inserted into the abdomen through holes the size of a dime, the idea of traditional open surgery may sound a bit scary. You may even wonder if it’s absolutely necessary.
But even though open abdominal surgery, called laparotomy, requires a hospital stay of several days, five or six weeks of recovery at home and a five-inch incision, there are times when it’s a godsend. That’s because laparoscopy is neither possible nor the technique of choice in every case.
When it comes to deciding between laparotomy and laparoscopy, your doctor’s expertise is your best ally.
One benefit of laparotomy is that it allows surgeons to confirm a diagnosis and treat the problem in one step. For example, if cancer is suspected, the surgeon can see how far the disease has spread and then remove all signs of it. The ability to diagnose and treat in one step is also useful when widespread infection or internal hemorrhage is suspected. And in cases of a ruptured ectopic pregnancy, laparotomy can be lifesaving.
A surgeon also may choose laparotomy when he or she needs to perform several tasks. For example, if a woman has surgery for infertility, the doctor can correct problems in the fallopian tubes and uterus and remove fibroids that may be interfering with conception—all through a single incision. Other uses for laparotomy include removal of large ovarian cysts and treatment of widespread endometriosis.
Laparotomy is almost always performed in a hospital, usually with general anesthesia. After the anesthesia has taken effect, the patient’s bladder is drained with a catheter (thin tube), which may be left in place for some time after surgery.
Usually, a horizontal incision of about five inches is made in the lower abdomen. If the surgeon suspects cancer or if extensive surgery is anticipated, a vertical incision may be made beginning just below the navel and extending to the pubic hairline.
Here’s what you can expect after a laparotomy: Once surgery is complete, you’ll go to the recovery room for about an hour, until you’re fully awake. Because abdominal surgery interferes with the functioning of the intestines, you won’t be able to eat or drink for two to three days after the procedure. Instead, you’ll receive intravenous fluids. Expect to stay in the hospital for about three to five days.
When you return home, you’ll need to take it easy for about six weeks. Arrange to have help with household tasks for the first week or two. Don’t drive until the pain around your incision has gone away. You will probably return to work five or six weeks after surgery.
Many people experience numbness around the incision. Feeling usually returns over a period of months. The scar may initially appear bright pink but will fade with time.
Several complications can arise from laparotomy. The most common are bladder infection and superficial infection of the incision. These are easily treated. If you have a more serious infection (See “Symptoms To Watch Out For”), you may need further surgery. Other possible complications include damage to the bladder or ureters (the tubes that carry urine from the kidneys to the bladder) and internal bleeding after surgery.
If you have a laparotomy, be alert for signs of infection or other problems, and rest as directed by your surgeon. These steps will go a long way toward ensuring a comfortable recovery.