laparotomy

A laparotomy is a surgical procedure involving a large incision through the abdominal wall to gain access into the abdominal cavity. It is also known as a celiotomy. The first successful laparotomy was performed without anesthesia by Ephraim McDowell in 1809 in Danville, Kentucky.

see minilaparotomy.

Patients presenting with traumatic intracranial and intraabdominal injuries often require emergent care. Triage of injuries is based on severity of the individual injuries, but treatment occasionally must proceed simultaneously. Determining an optimal patient position at the time of surgery often produces unnecessary delays and this delay may negatively affect patient outcome.

Photographs of traditional exploratory laparotomy patient positioning (position A), traditional supine craniotomy patient positioning (position B), and a hybrid patient position (position C) were presented to 29 general surgeons and 12 neurosurgeons at a single institution. Surgeons were asked to rate the positions on acceptability and to rank the three positions according to preference when simultaneous exploratory laparotomy and craniotomy were necessary.

Position C was rated as an acceptable option by 82.8% of general surgeons and 100% of neurosurgeons. In addition, 51.9% of general surgeons and 81.8% of neurosurgeons preferred position C to their respective specialty's traditional patient positioning in situations that required simultaneous exploratory laparotomy and craniotomy.

A novel hybrid operative patient position for use during simultaneous exploratory laparotomy and craniotomy. In doing so, its important of constructive dialogue among trauma surgeons and neurosurgeons in optimizing the care of acutely ill trauma patients with multi system injuries 1)


1)
Hernandez AM, Roguski M, Qiu RS, Shepard MJ, Riesenburger RI. Surgeons' perspectives on optimal patient positioning during simultaneous cranial procedures and exploratory laparotomy. South Med J. 2013 Dec;106(12):679-83. doi: 10.1097/SMJ.0000000000000030. PubMed PMID: 24305527.
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