Exploratory laparotomy

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Exploratory laparotomy
Intervention
ICD-9-CM 54.11

An exploratory laparotomy (ex-lap) is the standard of care in various blunt and penetrating trauma situations in which there may be multiple life-threatening injuries, and in many diagnostic situations in which the operation is undertaken in search of a unifying cause for multiple signs and symptoms of disease.

The trauma ex-lap is the most comprehensive ex-lap, usually undertaken after evidence of internal bleeding (a positive FAST, DPL, or other overwhelming evidence for internal hemorrhage). A midline incision is carried down to the linea alba and the fascia is incised. The peritoneum is entered and any immediate, life-threatening bleeding is identified and controlled. The lateral, superior, and anterior surfaces of the liver are packed with sponges, and the superior and lateral spaces around the spleen are similarly packed. The bowel is run from the ligament of Treitz to the terminal ileum. The gastrocolic ligament is incised and the lesser sac is explored, including the posterior stomach and the anterior pancreas. The surface of the spleen is examined for evidence of laceration and fracture. The liver is similarly examined. If necessary, Cattell and Mattox maneuvers may be performed to expose retroperitoneal structures. If the duodenum is at risk, a Kocher maneuver may be performed to examine the posterior duodenum and the head of the pancreas.

The ex-lap can lead immediately to a number of other procedures, including splenectomy, hepatic resection, repairs of the vena cava, repairs of the aorta, pericardial window, repairs of the iliac arteries or veins, distal pancreatectomy, enterotomy and bowel repair, small bowel resection, left hemicolectomy, right hemicolectomy, pyloric exclusion, gastric diversion, nephrectomy, and the "trauma Whipple."

Depending on the stability of a patient following an exploratory laparotomy, the abdomen may either be sutured closed primarily or may be temporarily closed with a vacuum dressing, saline bag, or towel clips to facilitate further non-surgical resuscitation prior to definitive closure.