Consent: Laparotomy

Original Author: Ollie Jones
Last Updated: February 14, 2019
Revisions: 8

This article is for educational purposes only. It should not be used as a template for consenting patients. The person obtaining consent should have clear knowledge of the procedure and the potential risks and complications. Always refer to your local or national guidelines, and the applicable and appropriate law in your jurisdiction governing patient consent.

Overview of Procedure

A laparotomy involves opening the abdominal cavity, typically through a midline approach, to allow for greater access to the abdomen, also allowing for assessment of each organ in turn, including inspecting the entire length of the bowel, palpating the liver and spleen, inspecting the gallbladder, and in the female assessing the uterus and ovaries.

Figure 1 – A midline laparotomy

Intra-Operative

Complication Description of Complication Potential Ways to Reduce Risk
Haemorrhage Particularly in the case of abdominal trauma, where the use of a cell-saver may be required, as well as a potential blood transfusion.
Injury to surrounding structures including bowel, bladder and ureter, liver, spleen A laparotomy involves assessing all organs, which can be damaged in the process. Decompress the bladder with a catheter (also important for intra-operative monitoring of urine output in major cases)
Bowel resection and formation of a stoma This is always a possibility in any bowel operation, either pathology-related or iatrogenic damage, and should be consented for
Anaesthetic Risks Includes damage to the teeth, throat and larynx, reaction to medications, nausea and vomiting, cardiovascular and respiratory complications. Forms a part of the anaesthetist assessment before the operation

Early

Complication Description of Complication Potential Ways to Reduce Risk
Pain The patient will most likely have an epidural or patient controlled analgesia to minimise this.

Local anaesthetic into the incision edges at closure will reduce wound-related pain

Bleeding There is a small chance of bleeding and bruising in the abdomen post-surgery. Depending on the reason for laparotomy packs may be left in place to arrest bleeding and removed the following day, e.g. in liver trauma
Infection Superficial wound infection is possible, however collections in the pelvis or paracolic gutters can also occur with intra-abdominal infections. Peri-operative antibiotics will reduce the risk of wound infections
Re-operation / intervention This occurs in 5-10% of emergency laparotomies, commonly due to anastomotic leaks, collections, or wound dehiscence.
Anastomotic leak Likewise, occurs in around 5% of emergency bowel resections.  If this occurs, the patient will usually require further surgery and stoma
Ileus Handling of the bowel can reduce the bowel motility, which can take several days to return to normal function Minimise excessive handling of bowel
Scarring A midline or transverse incision will result in a scar, which may form a keloid scar, particular in high risk ethnicities.
Blood Clots DVTs and PEs are a possibility in any operation. The risk is increased in patients with a raised BMI, on the pill, recent flights, previous DVT, pregnancy, smokers, cancer and prolonged bed rest. The patient will be given anti-embolism stocking and low molecular weight heparin peri-operatively to minimise this risk as deemed appropriate.
Stroke, MI, Kidney Failure, Death Although small, this is always a risk in any major surgery

Late

Complication Description of Complication Potential Ways to Reduce Risk
Hernia Any laparotomy incision has the potential to cause a hernia in the future. Avoid heavy life for 6 weeks post-surgery.
Adhesions Abdominal surgery may cause adhesions as a reaction to the procedure, which can result in adhesional bowel obstruction months to years after the operation

 

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