Laparotomy
Laparotomy (open, abdominal surgery) is a type of surgical approach in which the tissues of the anterior abdominal wall are dissected layer by layer to gain access to the organs of the abdominal cavity and pelvic cavity.
There are several types of incisions used in open surgery. In gynecology, a horizontal incision in the suprapubic region (Pfannenstiel laparotomy) 10−12 cm long is most commonly used. However, the type of incision depends on the reason for the surgery, specifically the size of the organ being operated on and the urgency of the procedure.
In case of large uterus or pelvic organ formations, as well as in case of emergency need for surgery (bleeding), a vertical lower midline incision is used (from the navel to the suprapubic region).
The most common types of incisions in gynecological surgeries
Laparotomy in gynecology is becoming less common these days; in most cases, it can be replaced by a laparoscopic approach. However, there are situations where laparoscopy cannot provide sufficient safety and speed.
Indications for laparotomy are:
- Emergency surgeries with significant blood loss;
- Large uterine fibroids (usually those with a uterus larger than 16−18 weeks of gestation), with multiple nodes or complex node arrangements, when the uterus is immobile in the pelvic cavity;
- Large ovarian tumors (more than 15 cm);
- Extensive adhesions in the abdominal cavity and pelvic cavity after previous laparotomies or in severe purulent-inflammatory diseases, when the likelihood of adhesions is extremely high;
- Lack of endoscopic surgical skills and equipment on the part of the surgeon.
Preparation and rehabilitation
Three days before surgery, we switch to a light diet: boiled meat, fish, broths, and fermented milk products. Fresh vegetables, fruits, legumes, and brown bread are temporarily excluded, as they put strain on the intestines.
We eat our last meal the night before, no later than 11:00 PM. On the morning of surgery, we are only allowed to drink water until 6:00 AM, and not a drop after that.
If the doctor suspects intestinal involvement (for example, with endometriosis), they will warn you in advance that special preparation with laxatives is required. This is not required unless indicated.
We eat our last meal the night before, no later than 11:00 PM. On the morning of surgery, we are only allowed to drink water until 6:00 AM, and not a drop after that.
If the doctor suspects intestinal involvement (for example, with endometriosis), they will warn you in advance that special preparation with laxatives is required. This is not required unless indicated.
We encourage you to get up early. If your condition allows and there are no contraindications, you can get up within a few hours. If your surgery was late in the evening, you can get up the next morning.
When getting up, we always wear a postoperative support bandage: it reduces pain and takes the pressure off the anterior abdominal wall. We also recommend wearing compression stockings for 2−3 weeks to protect your blood vessels from blood clots.
For the first 2−3 days, avoid foods that cause bloating or constipation: no soda, fresh baked goods, whole milk, or legumes.
When getting up, we always wear a postoperative support bandage: it reduces pain and takes the pressure off the anterior abdominal wall. We also recommend wearing compression stockings for 2−3 weeks to protect your blood vessels from blood clots.
For the first 2−3 days, avoid foods that cause bloating or constipation: no soda, fresh baked goods, whole milk, or legumes.
You’re usually discharged home within 3−5 days. The doctor determines this date based on your well-being and the extent of the procedure.
The sutures are straightforward. Most often, we use intradermal cosmetic sutures, which dissolve on their own and don’t require removal. If regular sutures are needed, they are removed after 7−10 days.
The sutures are straightforward. Most often, we use intradermal cosmetic sutures, which dissolve on their own and don’t require removal. If regular sutures are needed, they are removed after 7−10 days.
The main rule is not to be a hero. Physical activity is avoided for 1−2 months. Sexual abstinence is observed for 2 to 4 weeks, depending on the extent of the surgery.
All other recommendations—showering, suture care, and follow-up visits—will be prescribed individually by the doctor upon discharge. You’ll have a clear plan in hand so you don’t have to remember anything.
All other recommendations—showering, suture care, and follow-up visits—will be prescribed individually by the doctor upon discharge. You’ll have a clear plan in hand so you don’t have to remember anything.
Other types of surgical care
A full range of high-tech surgeries to solve complex gynecological problems.
Laparoscopy
A minimally invasive surgery for precise diagnosis and treatment of pelvic diseases through small punctures.
Hysteroscopy
A method for diagnosing diseases of the uterine cavity and cervical canal using an optical instrument (hysteroscope) with the possibility of simultaneous treatment under visual control.
Vaginal surgery
A non-incisional, vaginal approach. Effectively treats prolapsed organs, urinary incontinence, and pelvic floor aesthetic defects.