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 operationfor 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
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