EXPLORATORY LAPAROTOMY IN A SINGLE CENTRE GENERAL SURGERY UNIT: INDICATIONS AND OUTCOME
Orient Journal of Surgical Sciences
Vol 2[1] Jan - Dec, 2021

original article

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EXPLORATORY LAPAROTOMY IN A SINGLE CENTRE GENERAL SURGERY UNIT: INDICATIONS AND OUTCOME

 

Madubogwu CI (MB.BS, Msc, FWACS, FICS)
Department of Surgery, Chukwuemeka Odumegwu Ojukwu University Teaching Hospital, Awka. Nigeria.

Author for Correspondence: chymezo@yahoo.com

Citation:

Madubogwu CI. Exploratory Laparotomy In A Single Centre General Surgery Unit: Indications And Outcome.

 

Orient Journal of Surgical Sciences. Vol. 2. January - December, 2021. Page 20 - 25


ABSTRACT

Background: Exploratory laparotomy is a surgical procedure performed in a patient who requires surgery when the actual cause and nature of the disease is not certain. Exploratory laparotomy is usually carried out as an emergency procedure in patients who are acutely ill and require urgent operation for control and stabilization of their disease condition.

 

Objective: The aim of this study is to evaluate the common indications for exploratory laparotomy among general surgery patients and to assess their post-operative outcome and complications. Methodology: This is a three-year retrospective study extending from January 2014 to December 2016. All the consecutive general surgery patients who had exploratory laparotomy within the study period were recruited into the survey. Patient's demographics including: age, sex, diagnosis, intra-operative findings, operative procedures, complications and outcomes were extracted and analysed. Analysis was done using the SPSS version 21.0.

 

Results: A total of 120 exploratory laparotomies were performed out of 1,908 surgical operations conducted within the study period (6.29% of total surgery). The age range was 4 - 85 years with a mean of 40.25±17.23 years and peaks in the 21-30 years and 31-40 years age groups. Seventy-six patients were males and 44 females giving a male to female ratio of 1.73:1. Intestinal obstruction from colonic tumours was the commonest indication constituting 28 (23.3%) followed by complicated appendicitis at 26 (21.6%). Bowel obstruction from post-operative bands, perforated peptic ulcer disease (PPUD) and abdominal trauma accounted for 25 (20.8%), 17 (14.2%) and 16 (13.3%) respectively. A total of 12 patients had complications following surgery representing a complication figure of 10.0%. Mortality rate was 4.2%.

 

Conclusion: Exploratory laparotomy is still very relevant in general surgery practice. Intestinal obstruction from colonic tumour was the commonest indication in the study. Post-operative complications and mortality rate were relatively low at 10.0% and 4.2% respectively.


Keywords: Laparotomy, Indications, Complications, Mortality.

INTRODUCTION

 

The term laparotomy is derived from two Greek words: 'lapara' (meaning the soft anterior part of the trunk between the ribs and the pelvic bone) and 'otomy' (meaning making a surgical incision). Surgically, laparotomy is a procedure involving making a large incision through the abdominal wall to gain access into the abdominal cavity for diagnostic or therapeutic reasons.1

 

Exploratory laparotomy in itself is a surgical operation performed on a patient who requires surgery but the actual cause and nature of the disease is not known.1-3 On the other hand, therapeutic laparotomy is done a known disease which requires operation for its treatment.2,3 Exploratory laparotomy is usually conducted as an emergency procedure in patients who are acutely ill and require urgent operation

for control and stabilization of their disease condition.1,4

The indications for exploratory laparotomy are wide and varied. It is usually performed for cases of acute abdomen which have not responded to conservative measures or have shown rapid deterioration in patient's clinical condition.1-5 Indications may include: blunt and penetrating abdominal traumas with associated haemodynamic instability, bowel perforations, complicated inflammation of

some intra-abdominal viscera, small and large bowel obstructions, mesenteric ischaemia etc.1-5 Earlier before the advent and wide spread use of current advanced imaging techniques, most patients presenting with acute abdominal conditions underwent emergency surgical exploration.5-7

 

However, with the improvement in the use of modern imaging techniques and also with the current use of laparoscopy, the

 

n e e d f o r e x p l o r a t o r y l a p a r o t o m y i s dwindling.2,5,8

Nonetheless, the importance and place of exploratory laparotomy as a rapid and cost effective diagnostic and therapeutic tool

 

in the management of some cases of acute abdomen is still very apt.2,4,5,9

The objective of this study is to appraise the common indications for exploratory laparotomy in a General Surgery unit as well as to assess the post-operative outcome and complications.


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