Exploratory Laparotomy in South Africa

“Laparotomy” is the medical term for opening the abdomen surgically. An “exploratory” laparotomy is to investigate and treat the cause of an abnormality that is unknown via conventional imaging and laboratory studies. Since such surgery has risks, if a patient has already undergone the risk of surgery, there is a mindset that that all things to resolve preoperative problems be performed while in the surgery, which converts the exploratory laparotomy into a “therapeutic laparotomy.” For example, if it is being done for pelvic pain and a cyst on the ovary is discovered to be the cause, the cyst should be removed at the same time.

When is a Laparotomy Indicated?

There are many reasons that laparotomies are performed. There are necessary ones—as with malignancies; and then there are indicated but not necessary ones—such as for investigating pain or reasons for infertility. The most common reasons for laparotomy include:

·         Pelvic pain, which often has mysterious causes until laparotomy.

·         Ovarian cyst, which requires ruling out malignancy or endometriosis.

·         Hysterectomy, or removal of the uterus.

·         Suspicion of malignancy, which requires ruling out or confirmation.

·         To diagnose and treat endometriosis, a cause of pain and infertility.

·         To remove uterine fibroids, a cause of pain and infertility.

·         Trauma, when it is life-threatening.

How is a Laparotomy Performed?

Laparotomy is a surgery in which there is access to the abdominal cavity via opening the layers of the abdominal wall in compliance with sterile procedure—that is, in an operating room specifically designed to assure a clean environment and stocked adequately for any unforeseen emergency. Since it is a surgery, it is important that the facility in which laparotomy is performed have anesthesia available via an anesthesiologist and a blood readily available in the unlikely event it is needed quickly for any unintended blood loss. This means a facility with 24-hour anesthesia in-house and a blood bank.

What is the Difference Between a Laparotomy and a Laparoscopy?

Laparoscopy is used to gain access to the abdominal organs for surgery using small incisions through which a lighted scope is inserted for visualizing the area undergoing surgery, and the additional small incisions for small instruments attached to “poles,” which are inserted and manipulated through those small incisions. However, because laparoscopy also involves entrance into the abdominal cavity, it is still considered a laparotomy, with the same risks included. However, due to the minimal manipulation of tissue, complications, healing, and recovery are much less, hence its popularity.

What determines whether a laparotomy is performed the traditional way or via laparoscopy?

This is determined beforehand by the complexity of the surgery. If the limited access via small incisions and limited instrumentation means the goals of laparotomy cannot be accomplished, a “traditional incision” laparotomy is done, with either a vertical midline incision or a horizontal (“bikini”) incision. For example, if there is a solid 8-cm mass on the ovary, this will prevent removal through a 1-cm incision.

How Do You Prepare?

Because laparotomy enters a major body cavity, you must be evaluated medically with a full exam, lab work including blood and ECG, a pregnancy test, and a chest X-ray. The blood work should include clotting studies. You should refrain from taking any blood-thinners—even aspirin—for a week before. This may include certain herbal items over-the-counter (OTC), so you must provide a complete list of what you take—prescription and OTC—to your surgeon.

If you’ve had surgery before and suffered complications—including those from anesthesia—you must inform your surgeon.

Preparing for laparotomy means nothing to eat or drink at least 6 hours before surgery, because a full stomach, under anesthesia, can risk aspiration of stomach contents into your lungs. Also, an antibacterial wash the night before will help reduce infection.

How Does Medical Tourism Apply to Laparotomy?

When undergoing a laparotomy abroad, the key to safely returning home is being adequately recovered enough to safely travel. The three all-encompassing risks of any surgery involve one of 3 things:

1.      Bleeding.

2.      Damage to other structures during the surgery.

3.      Infection.

Usually, the progression of complications is

·         bleeding postoperatively will occur in the first 24 hours;

·         damage to other structures will become evident within 24 hours (as with bladder complications) or as long as a week (as with bowel complications);

·         infection will be the risk after that, with lungs (first), bladder (second), blood clots (third), and wound infection (the last to occur). Nevertheless, this whole range runs its course of risk after about a week.

To be considered safe to travel, therefore, a patient with an uneventful postoperative course should wait for at least 10 days. Of course, if any of the above complications occur, this will delay travel accordingly.