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Laparotomy – opening and
closing
Mr Maheshwar Naidoo
FCS(SA)
Ngwelezana Hospital
South Africa
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)
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
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
Midline laparotomy incision – layer by layer
L
• External oblique
• Internal oblique
• Transversalis muscle
Linea alba
Sheath layers above umbilicus
Sheath layers below umbilicus
Laparotomy – opening and closing
Cleaning and draping/ operative tray
Exploratory
laparotomy
Abdominal closure
• As per video but use toothed Bonney/ Ramsey forceps rather than
hands
• Skin – reserve skin clips for SSG
Review in SOPD
ROS as local clinic
Open abdomen =LAPAROSTOMY
Complication of a “Bogota Bag”
End
questions

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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
  • 7. Cleaning and draping/ operative tray
  • 9. Abdominal closure • As per video but use toothed Bonney/ Ramsey forceps rather than hands • Skin – reserve skin clips for SSG
  • 10. Review in SOPD ROS as local clinic
  • 11. Open abdomen =LAPAROSTOMY Complication of a “Bogota Bag”