A surgical procedure involving a large incision through the abdominal wall to gain access into the abdominal cavity.
It is also known as celiotomy.
In diagnostic laparotomy the nature of the disease is unknown, and the procedure is the best way to identify the cause.
For a therapeutic laparotomy, the cause of the intraabdominal pathology has been identified and laparotomy is required for its therapy.
About 2 million performed per year.
Depending on incision placement, gives access to any abdominal organ or space.
The most common incision for laparotomy is the midline incision.
A midline vertical incision follows the linea alba, and usually extends from the xiphoid process to the umbilicus.
A lower midline incision is limited by the umbilicus superiorly and by the pubic symphysis inferiorly.
Sometimes a single incision from xiphoid process to pubic symphysis is employed in trauma cases.
Midline incisions are particularly favored in diagnostic laparotomy.
The Kocher incision is a right subcostal approach appropriate for certain operations on the liver, gallbladder and biliary tract.
A right lower quadrant incision is performed for appendectomy.
The Pfannenstiel incision, a transverse incision below the umbilicus and just above the pubic symphysis, is the incision of choice for Cesarean section and for abdominal hysterectomy for benign disease.
A variation of the Pfannenstiel incision is the Maylard incision in which the rectus abdominis muscles are sectioned transversally to permit wider access to the pelvis.
Lumbotomy refers to a lumbar incision which permits access to the kidneys without entering the peritoneal cavity, typically used only for benign renal lesions.
A related procedure is laparoscopy. P
3-20% result in incisional hernia.