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 infrequently used at this time. Instead, most surgeons and providers will opt for laparoscopic surgery, if possible. In relation to endometriosis, 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 women are able to have a laparoscopic surgery depending on the nature of their endometriosis and their personal medical history. If your provider recommends surgery, but you are unable to have a minimally invasive laparoscopic procedure, they may suggest a laparotomy instead.
What happens during a laparotomy?
During a laparotomy, an individual is under general anesthesia, which means they are asleep. A large incision is made in the abdomen. This incision might be horizontal at the bikini line, and look similar to a C-section (caesarean 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. 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, called endometriomas, from the ovaries. Ultimately, as much endometriosis is removed as possible during this procedure to hopefully relieve pain and other endometriosis-related symptoms. Bands of tissue (also called adhesions) within the pelvis may be removed in order to help improve fertility.1-3
In some cases, your provider may be removing whole structures from within the pelvis, such as one or both ovaries, the fallopian tubes, or the uterus (called a hysterectomy). However, undergoing a laparotomy for endometriosis often focuses on removing endometriosis only. Your provider 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 healthcare 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 our urine without you needing to get up and go to the bathroom. You will be given pain medications and IV (intravenous) fluids through your arm to keep you comfortable and hydrated. Your healthcare team may help you to get up and move around the following day after your procedure to help prevent blood clots and other post-operation complications.1,2
You will be discharged and sent home with instructions and medications when your healthcare team feels you're ready. You will be required to follow any instructions given and to monitor yourself for any potential issues. It can take two to six weeks, or more, to get back to your normal activities after surgery. You may need to have a caregiver around at home to help you get around the house and to perform other necessary tasks for you.1
What are the risks of a laparotomy?
There are more risks associated with undergoing a laparotomy for the treatment of endometriosis when compared to laparoscopic (minimally invasive) surgery. This is because a larger incision is made and the procedure has a longer recovery time. Some common risks associated with a laparotomy include, but are not limited to:
- Severe bleeding (hemorrhage), including internal bleeding
- Injury to internal organs such as the bladder or the bowel that may impact their functioning
- 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 than requires surgical treatment
- Development of blood clots
- Development of scar tissue (adhesions) that can cause similar symptoms as before the procedure1-3
This is not an exhaustive list of all potential risks and complications of a laparotomy. Consult your surgeon or healthcare provider for a full list of signs to watch for in your specific situation.