Laparotomy vs Laparoscopy
Laparoscopy and laparotomy are two approaches to abdominal surgery. Laparotomy is the older of the two and laparoscopy is a very recent development. Both conditions have their advantages and disadvantages. It is the decision of the surgeon to choose between the two approaches. This article will discuss both approaches in detail highlighting their advantages and disadvantages and the differences between them.
Laparotomy is the opening of the abdominal cavity to get at the organ which needs the surgical procedure. Laparotomy is done mostly under general anesthesia, except in special circumstances like caesarian section. There are specific sites for surgical entry when it comes to laparotomy. Appendix, which is located at the lower right corner of the abdomen, needs a small incision called grid-iron incision placed midway between the umbilicus and the anterior superior iliac spine. Cholecystectomy needs an incision placed at the upper right corner of the abdomen. Major bowel surgery may need a midline incision.
It is very important to note that the structures cut by the incision differ greatly due to the anatomy of the abdominal wall. Special techniques are used to minimize blood loss, minimize tissue injury and improve recovery. Initial surgical incision is made along one of the skin creases because incisions made parallel to the skin creases bear less strain and heal faster. Muscles are never cut, but separated. There is much debate going on whether the peritoneum should be closed when closing the abdomen. However, the general rule is it is safer to close the peritoneum because it reduces the risk of post-operative adhesion formation. Because laparotomy exposes the intra-abdominal content, there is a higher chance of infection and dehydration. Therefore, antibiotic cover is essential and fluid management should take into consideration the extra water loss.
Laparoscopy is a modern method of minimally invasive surgery. Laparoscopy needs special equipment and a high resolution display device to visualize the intra-abdominal contents during surgery. Laparoscopy is also done almost always under general anesthesia. Special cases such as laparoscopy assisted vaginal hysterectomy may be done under spinal anesthesia. At the start of the surgery, the initial incision is at the umbilicus. This is the port of entry for the verus needle. The abdomen is pumped up with carbon dioxide. Because diathermy is a possibility during surgery, oxygen is never used to inflate the abdomen to prevent the obvious risk of ignition. After the abdomen is inflated the camera goes in through the verus needle. Two or three additional ports are cut on either side of the initial incision. The whole surgical procedure is done with long instruments, and a TV shows what is being done. After the surgery, the gas and the instruments are removed, and a simple closure is enough. Laparoscopic surgery takes a while if inexperienced.
What is the difference between Laparoscopy and Laparotomy?
• Laparoscopy is a modern procedure while laparotomy is not.
• Laparoscopy needs special cameras and display devices while most laparotomies do not.
• Laparoscopy needs a small port of entry while laparotomy opens up the abdomen.
• Laparoscopy needs inflation with a gas to get a good field of vision while laparotomy gives a good exposure after the initial entry.
• Laparoscopy may not be successful with large intra-abdominal masses and cancers while laparotomy is the fall back measure in case of failure.
• Recovery time after laparoscopy is shorter than that after laparotomy.
• Post-operative pain is less in laparoscopy.