EXPLORATORY OPERATION (EXPLORATORY LAPAROTOMY)

v GENERAL INFORMATION This used to be a very common operation because there were so few other ways to look at organs inside the abdomen (and even these few were not so good). Surgeons had to open up the abdomen to explore the inside. EXPLORATION Now there are a number of ways to exploreor look insidethe abdomen without actually having to open it up. A few of these newer methods are the following: Ultrasound: Harmless sound waves are aimed at your abdomen. The sound waves bouncing back (the echoes) from this area are seen as a picture on a screen. This is a convenient, painless, and harmless way to examine organs and tissues inside your abdomen. CT Scan (Computed Tomography Scan): These pictures are taken by a special x-ray machine shaped like a huge doughnut. You will lie on the table inside the hole in the doughnut. The x-rays are taken as very thin slices through any area of the body. This makes it possible to see the ne details in the area being examined. MRI (Magnetic Resonance Imaging): No x-rays are used with this technique. Instead, magnetic elds and radio waves are used. A computer develops the pictures to show organs from several angles. It is especially valuable for examining blood vessels and nerve tissue. PET Scan (Positron-Emission Tomography Scan): This is one of the latest and most sophisticated ways of looking at tumors. This technique not only can locate tumors but also can show how active they are biologically. Colonoscopy: This is done with an optical instrument called a colonoscope. It is smooth, exible, and as big around as your little nger and has a light at its tip. You will be given medicine that will make you feel drowsy during the procedure. The tip of the instrument will be lubricated and then gently inserted into your anus. It can be used to inspect your entire large bowel. Laparoscopy: This method uses a rigid optical instrument called a laparoscope. It is as big around as the tip of your little nger and has a light at its tip. With the patient asleep, the laparoscope is inserted into the abdomen through a very small incision in the navel so the inside of the abdomen can be examined directly. If something suspicious is seen, a tiny piece (a biopsy) can be removed for laboratory examination. ERCP (Endoscopic Retrograde Choledochopancreatography). This is an optical instrument (an endoscope) that has a light at its tip and is smooth, exible, and about the size of your little nger. After the mouth and throat are sprayed to make them numb, the patient is given medicine and is put into a twilight sleep. The instrument is inserted through the mouth, down the esophagus, past the stomach, and to the duodenum, where the bile duct empties its juices. A special tube (thinner than a toothpick) is then passed out of the instrument into the bile ducts coming from the liver. Pictures of the bile ducts can be taken to look for stones or other problems. Often the problems found can be taken care of at the same time. Peritoneal Lavage: This is most often used in persons who have had an injury to the abdomen and often to other areas as well. Sometimes it is difcult to know if there is bleeding or infection inside the abdomen. Although this is an important question, there may be injuries to other areas of the body that need prompt attention. Which should be taken care of rst? A very thin plastic tube is inserted into the abdomen, and through this plastic tube a bottle of salt solution is instilled into the abdomen. After a short while, the salt solution is removed through the same tube and examined for any red blood cells, white blood cells, bacteria, or chemicals. This procedure may provide information about what may be happening inside the abdomen. These and other modern techniques help doctors see inside the abdomen. This does not mean that the abdomen does not need to be opened to make the diagnosis and take care of the problem. What it does mean is the following: The abdomen does not always need to be opened to nd out what is wrong. Sometimes biopsy and observation not only can make the diagnosis but also can show that the problem does not require specic careit will get well by itself. Or the problem can be taken care of with medicine and x-rays rather than with a formal operation. The surgeon can know what is wrong beforehand and so can make plans to take care of the problem without any surprises. Also, the patient knows what to expect. Sometimes a laparoscope can be used to both make the diagnosis and to take care of the problem. It can spare a patient with multiple injuries, and possible but unknown injuries to the abdomen, an unnecessarily wide opening of the abdomen to determine whether anything is actually wrong. This then allows the doctor to take care of the other injuries without worrying about missing something serious in the abdomen. Now an exploratory abdominal operation can be more focused. The surgeon more often knows what is there and what needs to be done. These new techniques and a number of other associated advances are the reasons that abdominal operations are now more appropriate, safer, and more effective.