Laparotomy

A laparotomy is a surgical procedure in which a large incision is made in the abdomen in order to view and address issues within the abdomen and pelvis. Laparotomies are no longer common. Instead, most doctors now opt for laparoscopic surgery, if possible.

Laparoscopic surgery involves making a small incision in the abdomen and using small, thin tools to investigate, remove, or destroy endometriosis lesions. However, not all people are able to have a laparoscopic surgery depending on their endometriosis and medical history. If your doctor suggests surgery but you are unable to have a minimally invasive laparoscopic procedure, they may suggest a laparotomy instead.

A diagram of a laparotomy where surgical retractor tools are being used to open the lower abdomen where an incision has been made in order to access the female reproductive organs to identify any lesions and treat endometriosis.

How does a laparotomy help manage endometriosis?

During a laparotomy, a large incision is made in the abdomen. The incision might be horizontal at the bikini line and look similar to a C-section incision. Or, it may be a vertical incision depending on the nature of your procedure. The incision can be as long as 15 to 20 centimeters in length. The procedure is usually done under general anesthesia.1-3

Once your surgeon makes the incision, they will be able to view the inside of your abdomen and pelvis. From there, they may remove endometrial-related cysts (endometriomas) from the ovaries. As much endometriosis is removed as possible to hopefully relieve pain and other endometriosis-related symptoms. Bands of tissue (adhesions) within the pelvis may also be removed to help improve fertility.1-3

In some cases, your surgeon may remove whole structures from within the pelvis. This may include 1 or both ovaries, the fallopian tubes, or the uterus (hysterectomy). However, undergoing a laparotomy for endometriosis often focuses on removing endometriosis only. Your doctor or surgeon will talk with you about what they are planning to do in your specific situation.

What happens after a laparotomy?

After your laparotomy, you will need to remain in the hospital for several days. Your care team will monitor you for any changes in your blood pressure, temperature, and pulse. They will also monitor your wound site to make sure it is clean and dry. You may have a urinary catheter to drain your urine without you needing to get up and go to the bathroom. You will be given pain medicines and IV (intravenous) fluids through your arm to keep you comfortable and hydrated. Your care team may help you to get up and move around the day after your procedure to help prevent blood clots and other complications.1,2

You will be discharged and sent home with instructions and medicines when your care team feels you are ready. You will be required to follow any instructions given and to monitor yourself for any potential issues. It can take 2 to 6 weeks, or more, to get back to your normal activities after surgery. You may need to have a caregiver at home to help you get around the house and do other necessary tasks for you.1

What are the possible side effects of a laparotomy?

There are more risks associated with a laparotomy for the treatment of endometriosis when compared to laparoscopic surgery. This is because a larger incision is made and the procedure has a longer recovery time. Common risks of a laparotomy include:1-3

  • Severe bleeding (hemorrhage), including internal bleeding
  • Injury to internal organs such as the bladder or bowel
  • Infection, especially operation site infection, pelvic infection, or urinary tract infection
  • Development of scarring at the incision site
  • Numbness near the incision site
  • Development of a fistula (connection) between the vagina and bladder that requires surgical treatment
  • Development of blood clots
  • Development of scar tissue (adhesions) that can cause similar symptoms as before the procedure

These are not all the possible side effects of laparotomy. Talk to your doctor about what to expect or if you experience any changes that concern you during treatment with laparotomy.

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Written by: Casey Hribar | Last reviewed: August 2021