Emergency Exploratory Laparotomy - Abdominal Incision

HOW BIG DOES AN EX-LAP INCISION NEED TO BE?😷 I am a firm believer that the incision must extend from the xiphoid to the pubis. The reason being is that you need to be able to assess all the organs and palpate the entire gastrointestinal tract from the stomach to the colon.

Just because you see a rock on radiographs doesn't necessarily mean that is the only pathology present. There could be: - Two foreign bodies eg. one in the stomach that you can't see on with imagery
Pathology in another organ eg. spleen or liver mass, pancreatitis etc.
You definitely can't assess all the organs properly if the incision you make is only half the length of the xiphoid to pubis. 🤓

I have seen the consequences of small ex-lap incisions:
Missed second foreign body
Longer surgery times and trauma to organs trying to work through small incisions with limited access to organs, one of my own cases several years ago where I caused a splenic mass to bleed more as I tried to pull it through an incision that was in hindsight, too small.

I get it might take longer to close the abdomen, but I would rather make sure I visualise and assess everything rather than miss something AND have the appropriate space and exposure to properly do what I need to do.

Nothing is more satisfying than watching your patient wake up from a procedure smoothly. Postoperatively, I always make sure the patient is covered with appropriate levels of pain relief and often opt for multimodal analgesia.
When it comes to wound healing, it occurs ‘cut edge to cut edge’ so from side-to-side, not from one end to one end. This means that an incision line that is 10cm long will heal in the same time as one that is 5cm long, so why not make it easier for yourself, and allow yourself the working space to do a thorough job.

Tip: Always warn owners how long the incisions will be before going to surgery and then again when they come down for a visit as it can be a shock to them as they are often used to keyhole incisions.

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