Basic structure of hair and hair growth cycle.pptx
Laparotomy – opening and closing
1. Laparotomy – opening and
closing
Mr Maheshwar Naidoo
FCS(SA)
Ngwelezana Hospital
South Africa
2. Watch Video
• 8 minutes
• VTS_03_1.VOB (“How to Operate”)
• Reading material
• Farqharsons 10th Ed, Chapter 13, pages 209-225
• Scott-Conner and Dawson, 4th Ed, Chapter 44, Pages 246 -255
• SRB’s surgical operations: Text and Atlas, Chapter 3, Pages 34 - 67
• How to Operate - For MRCS Candidates and Other Surgical Trainees DVD (3
DVD Set)
3. How many different laparotomy incisions are
there?
• A= Vertical midline
• B= paramedian
• C= gridiron
• D= Lanz / Rockey Davis
• E= Pfannenstiel
• F= Suprapubic
• G= Transverse upper abdominal
• H= Subcostal (Kocher incision)
• I= Oblique iliac muscle cutting incision
• J = Chevron / Rooftop/ bilateral subcostal incision
LAPAROTOMY IS A MISNOMER.
Correct technical term is a celiotomy.
J
4. Position of patient Name of this position?
Lithotomy?
Lloyd Davis
For laparotomy
• Supine
• Position of patient’s upper limbs?
• Foley catheter?
• NGT?
• DVT prophylaxis?
• NO contact between patient’s skin and any metal object
• Pressure necrosis prevention
• Avoid leaning on the patient
• Ergonomic position and posture of surgeon
5. Midline laparotomy incision – layer by layer
L
• External oblique
• Internal oblique
• Transversalis muscle
Linea alba
Sheath layers above umbilicus
Sheath layers below umbilicus