Essay On Explorative Laparotomy

Introduction: Penetrating injuries of the abdomen are traditionally treated with exploratory laparotomy .The high non-therapeutic laparotomy rate and associated morbidity after mandatory laparotomy for abdominal stab wounds led to the current selective non-operative management strategy [1–3]. It is reported that 50–70% of abdominal stab injuries penetrate the peritoneum, but 20–40% of these penetrating wounds do not lead to significant organ injury [4]. Despite the growing use of diagnostic methods such as abdominal ultrasonography (US), computed tomography (CT), diagnostic peritoneal lavage (DPL), intravenous pyelography (IVP), and angiography, it is still difficult to evaluate the severity of penetrating abdominal stab wounds [5]. Patients with penetrating abdominal stab wounds are managed non-operatively in many centers, despite the fact that an explorative laparotomy may be an appropriate treatment strategy in selected patients. The criteria defining when an explorative laparotomy is appropriate state that hemodynamic instability and signs of peritonitis must be present. Hemodynamically stable patients without signs of
The first trocar for 10 mm laparoscope (30º) was inserted at the umbilicus. After the abdomen has been entered, the anterior abdominal wall at the site of the stab (that was depressed with a finger) was examined to detect peritoneal violation. If the peritoneum was intact the procedure was terminated. If there is violation of the peritoneum another two 5 mm trocars were inserted at the right and left paramedian sites at the level of the umbilicus for systemic examination of the abdomen using a traumatic bowel graspers. If no injury was identified, the procedure was terminated and the patient was put under observation. If injury was found, it was either managed laparoscopically or with exploratory