What is an Exploratory Laparotomy?

An exploratory laparotomy, sometimes referred to as an ex-lap, is a surgical procedure performed for diagnostic purposes. The surgeon makes an incision to access the abdominal cavity and investigates the contents to look for an explanation for a patient's symptoms. Depending on what the surgeon finds, additional procedures may be performed or the surgeon may close the incision. The exploratory laparotomy procedure is performed in an operating room, usually by a general surgeon with the assistance of a surgical team including an anesthesiologist and operating room nurses.

There are a number of reasons why a patient might need an exploratory laparotomy. Even with advanced medical imaging techniques, sometimes signs of disease do not show up on imaging studies, and it may be necessary to physically examine the area in question. A patient may have vague or intermittent symptoms that are difficult to link with any known cause, or a surgeon may want to be able to take biopsy samples for the purpose of laboratory analysis.

In an exploratory laparotomy, the patient is fully anesthetized and a surgeon makes an incision to reach the area of interest. Many operating rooms have cameras and displays that can be used to record surgical procedures so that the surgeon can review the procedure later. The surgeon examines the contents of the abdomen, looking for signs of lesions and other abnormalities. Some structures may be elevated out of the abdominal cavity for closer inspection and palpation, with the surgeon looking for subtle differences that might be indicative of a medical problem.

If a surgeon feels that it is necessary, biopsy samples can be taken during an exploratory laparotomy. Likewise, if a life-threatening issue is identified, the surgeon will correct it. In other cases, the surgeon will take note of any diagnostic findings, close the incision, allow the patient to wake up and recover, and discuss the findings of the surgery with the patient. The patient may be presented with some treatment options if the surgeon was able to make a diagnosis.

This procedure contrasts with a therapeutic laparotomy, where the patient's abdomen is opened in a surgical procedure that is intended to fix a problem such as a ruptured appendix. Many surgeons use laparoscopy, where cameras and instruments are inserted through small incisions, in lieu of laparotomy, a much more invasive surgery that involves making a large incision. Healing after a laparotomy takes longer and the patient is exposed to more risks in an open procedure.