“Laparotomy” is abdominal surgery. A surgeon can use it to check for damage, take samples for biopsy, repair tissue, or remove parts that have extensive damage. In layperson terms, ‘laparotomy’ is ‘open surgery’, meaning it requires a large opening to afford a clear view to the surgeon. Laparotomy requires sedation.
Laparotomy is never the first round of treatment administered to a patient with abnormal symptoms of gynaecological health. For instance, cases of ovarian cysts, blockages in the fallopian tubes, or endometriosis are often treated using laparoscopy. Doctors resort to surgery only if the condition is not improved by the use of drugs or hormone therapy. Younger patients or those with conditions that are diagnosed at relatively earlier stages can benefit from less intensive treatment. When surgery is required, most modern practitioners prefer laparoscopy over laparotomy.
Laparoscopy is less expensive, has a shorter recovery period, and a lesser chance of complication. For this reason, it is preferred as the primary recourse when symptoms of pelvic pain are noticed.
Laparotomy is more of an emergency line of treatment if laparoscopic management or draining of an abscess, such as in the case of endometriosis, proves ineffective. Laparotomy allows the surgeon to repair or remove the organs if the damage is extensive.
It is used to improve the gynecologic and general health of the woman by treating conditions that could not be treated using several rounds of medical therapy.
Some of the conditions under which laparotomy is recommended are:
- Pelvic Inflammatory Disease
- Uterine Fibroids
- Ovarian Cysts
- Uterine Fibroids
These are conditions associated with extreme pain and discomfort, heavy bleeding during menstruation, and irregular or lengthy periods.
Pelvic Inflammatory Disease (PID): This is the condition of infection in the female reproductive system. It usually starts with sexually transmitted bacteria spreading an infection to the uterus, fallopian tubes, or ovaries. The symptoms of PID are not always pronounced. It may be detected in later stages when a woman is unable to get pregnant or has developed extreme cases of pelvic pain.
A considerable percentage of women with PID face Tubo-ovarian abscess (TOA) – the development of a mass of tissue that blocks the fallopian tubes. This is often caused by bacteria such as E.coli. Cases of advanced PID or TOA in which the patient does not respond to laparoscopic treatment can be treated using laparotomy (among other options such as subcutaneous drainage). This is treated as an emergency case because the chances of rupture of an abscess or vessel erosion are associated with a growing risk of life-threatening situations such as sepsis. However, a laparotomy cannot be performed when inflammation or infection is high. Several rounds of treatment are used to control these conditions before a laparotomy can be performed.
TAH + BSO: It is an abbreviation for Total Abdominal Hysterectomy and Bilateral Salpingo-Oophorectomy. That means an open abdominal surgery is carried out to remove the entire female reproductive system – the uterus (hysterectomy), the fallopian tubes (salpingectomy) on both sides, and both the ovaries (oophorectomy).
Such surgery is recommended when all attempts at medical therapy using drugs, hormones, and combinations of treatment have proved fruitless. In some cases, a patient does not respond to laparoscopic management and laparoscopic drainage of the abscess. In worse cases, a recurring condition can require more than a combination of hormone therapy and laparoscopic management. In such cases of advanced damage, a doctor advises laparotomy for TAH + BSO.
Ovarian Cancer: In the case of a suspected cancerous tumor in the ovary, a laparotomy is used to check for the presence or the extent of cancer. The surgeon looks to ‘debulk’ the system of as much of cancer as possible. This is a major abdominal surgery in which the surgeon looks to remove as many signs of cancer as possible – removing the uterus, both fallopian tubes, both ovaries, and cervix might be deemed necessary upon an exploration of the abdomen. Some lymph nodes may also be removed from the region to check if they have become cancerous.
It is difficult to retain fertility in cases requiring TAH + BSO.
In special cases where cancer is noticed in a single ovary, a unilateral oophorectomy or salpingectomy may be performed in an attempt to give the woman a chance to bear a child.
Uterine Cancer: Uterine cancer in most cases begins as a cancer of the innermost layer of the uterus – the endometrium. Early indications of abnormal growth in the endometrium are vaginal bleeding in between menstrual cycles, the onset of periods early in life, and obesity. With the amount of clinical data and research available, there is a clear preference for laparoscopic surgery over laparotomy. Findings maintain that the recurrence of cancer is not vastly different in laparoscopy when compared to results after a laparotomy. Especially in the early stages of endometrial cancer, laparoscopy allows viewing, diagnosis, and if necessary, removal of the entire uterus and the nearby reproductive organs.
Clinical trials and data support the use of laparoscopy over laparotomy as the former has lower chances of hemorrhaging, fewer overall risk of complications, and a shorter hospital stay.
To decide whether laparotomy is the right avenue of treatment, doctors take into account:
- The patient’s age
- The extent of the disease
- Symptoms that make the condition tolerable in day-to-day life
- The reproductive goals of the patient
Awareness of your own goals and seriousness of the condition can help you co-operate with your doctor in treating it.
Dr. Lavanya Kiran | Senior Consultant – Obstetrics & Gynaecology | Mazumdar Shaw Medical Center, Bommasandra, Narayana Multispeciality Clinic, Electronic City – Velankani & Narayana Multispeciality Clinic, Jayanagar