Laparoscopy or laparotomy are widely used in surgical practice as methods of treatment and diagnosis of various diseases requiring surgery.
Laparotomy is a traditional technique used by surgeons to gain access to the patient's pelvis and abdomen. In other words, it is an open cavity operation with a layered longitudinal or transverse section (cross-section) of the skin and muscle tissues of the anterior abdominal wall to visualize the internal organs. Until recently, laparotomy was the only way to perform cavity operations.
Laparoscopy is a modern minimally invasive method of surgical intervention in the patient's body through 2 (or more) small punctures in the abdominal wall. Laparoscopy was originally developed for the diagnosis and treatment of gynecological diseases. For more than 35 years this method has been widely used for the surgical treatment of cancer, obesity, urological and other internal human diseases.
HOW DOES LAPAROSCOPY DIFFER FROM LAPAROTOMY
The difference between these two procedures is the method of cutting integumentary tissues. Accordingly, the tools for these methods will be different. Laparotomy usually requires cutting the skin and muscle tissue of the abdomen from 5 to 25 cm in length in order to visualize and easily access the surgeon to the patient's internal organs. Laparoscopic surgery uses the keyhole method, which eliminates the need for such large incisions as in the previous case. This is the main difference between laparoscopy and laparotomy.
The surgeon sees a problematic organ from the inside of the body using a laparoscope - an optical device equipped with a light source and a tiny video camera. This device is inserted into the patient's abdomen through a small puncture in the umbilical area along the trocar (a surgical instrument in the form of a narrow hollow tube). Before the operation, the abdomen is inflated using carbon dioxide. The video camera transmits a clear image of the internal organs to the computer monitor. If necessary, the image can be increased several times.
Looking at the screen, the surgeon performs the necessary medical manipulations with special tools. They are inserted through the trocars into additional incisions. They are usually made 3-4, their diameter is from 5 to 10 mm. For a diagnostic laparoscopic procedure, one incision with a diameter of 7-10 mm is enough.
WHAT ARE THE ADVANTAGES OF LAPAROSCOPY IN COMPARISON WITH LAPAROTOMY AND VICE VERSA
In modern surgical practice, the laparoscopic method in comparison with laparotomy is becoming increasingly popular due to a number of advantages. Namely:
- short stay in the hospital after surgery, which usually does not exceed 2-3 days;
- the recovery period is easier and faster. Within a day the patient can walk and take care of himself independently;
- due to less tissue injury, patients do not have strong pain sensations, and therefore do not need to take strong painkillers;
- postoperative scars soon become almost invisible;
- significantly reduces the risk of postoperative hernia. The abdominal wall at the site of a large incision during laparotomy is weakened, and this can lead to hernias. At laparoscopy similar happens extremely seldom (infrequently);
- the risk of wound infection and heavy blood loss is much lower;
- reduced risk of adhesions processes, inflammation, divergence of surgical sutures.
MAIN ADVANTAGES OF LAPAROTOMY:
- technical simplicity of the operation, which does not require complex tools and special training of the surgeon, unlike laparoscopy;
- laparotomy is required in case of urgent surgery, in emergency cases. For example, if a patient has suffered a serious injury with bone fractures and damage to internal organs. Laparotomy is used in a life-threatening condition, as well as bleeding for an unknown reason or bleeding that cannot be controlled, even if the cause is established;
- laparotomy method is also reserved for cases when during laparoscopy there is a need for a large incision to provide a wider visualization of internal organs and expand the operating field. For example, in the case of detection and subsequent removal of numerous or large ovarian cysts, resection or extirpation of a cancer-affected organ.
Life-threatening complications that can occur during laparoscopic and laparotomy interventions, as well as in the postoperative period, are approximately equivalent, but are extremely rare (0.3% of cases).
WHICH METHOD TO CHOOSE?
The decision on which surgical method should be preferred depends on the preoperative diagnosis and the general state of patient’s health of. The technical capabilities and equipment of the operating room, the experience and qualifications of the doctor are also taken into account. The main contraindications to the use of the laparoscopic method are:
- cardiovascular disease in the stage of decompensation;
- coma, shock;
- severe exhaustion;
- problems with blood clotting;
- hernia and the presence of adhesions from previous surgical interventions;
- an infectious disease transmitted shortly before the planned operation;
- pathology of internal organs of significant size.
The patient needs to discuss with the doctor all the risks, advantages and disadvantages of each method. Contact the bariatr.com team. This center is equipped with high-quality medical equipment in Ukraine and has an arsenal of energy tools from world manufacturers. Consult PhD candidate, bariatric surgeon Andrian Reity, who has 19 years of experience in performing successful laparoscopic surgeries to find out all the issues related to surgical treatment of obesity.