Laparotomy


The most frequently used sections of the abdominal wall:
1 - the white line of the abdomen above and below the navel; 2 - angled.

Laparotomy (chrevosechenie) - opening the abdomen. Running the operations in the abdominal organs. Diagnostic, or trial, laparotomy is to clarify the nature of the disease. Preparation for laparotomy begins the day before or a few days, depending on the intended operation. The patient receives a bath, he shaved the hair in the area of operational fields, cleanse the bowels using enemas. The presence of pustules, eczema even in remote from the abdominal wall areas of the skin is a contraindication to the planned laparotomy. Older and weakened patients need special preoperative preparation, aimed at improving the function of the respiratory and cardiovascular systems. To do this, the patient is taught to deeply and evenly breathing, injected drugs that stimulate the heart and improves blood circulation. Exhausted and dehydrated patients prescribed intravenous infusion (glucose, salt solutions, the blood), vitamins, etc. Laparotomy is performed under local anesthesia or General anesthesia. In the latter case it is possible to introduce additional muscle relaxants, good relaxing the abdominal wall. The skin of the abdominal wall treated with alcohol and iodine tincture. The nature of the incision depends on the location of the affected organ (Fig. ). For example, when appendicitis use angle cut in the right iliac region (see Appendectomy), gastric surgery incision is carried out on the midline of the abdomen from the xiphoid process up to the navel and so on, When the median cut cut through the skin, subcutaneous tissue, the aponeurosis on the white line, preperitoneal cellulose, peritoneum; in operation for appendicitis cut through the skin, subcutaneous tissue, the aponeurosis of the external oblique muscle, pushing fiber internal oblique transverse muscle, cut preperitoneal cellulose, peritoneum. After the operation - you must make sure there is no bleeding. In order to avoid the abandonment of foreign bodies in the abdominal cavity (napkins, tools, and so on) ends large napkins attach alligator clips to the operational linen and small towels and balls strengthen the clamps. Operating sister produces account napkins and tools before and after surgery. The wound is sutured in layers. The peritoneum and the muscles are sewn together with catgut, aponeurosis and skin - silk threads. Postoperative use morphine, pantopon, promedol, antibiotics (penicillin, streptomycin, neomycin, and others), saline solutions intravenously, appoint banks, mustard, exercise therapy. When nausea and vomiting carry out constant aspiration of gastric contents trehanoc water sucking. First cleansing enema put on the 3-4th day. It is necessary to monitor the operating condition of the wound and at the first sign of festering remove 1-2 seam, and put a bandage (sticker) with a 10% solution of sodium chloride.