Drug Therapy After Exploratory Laparotomy Surgery - Explained

Introduction

Laparotomy surgery is a diagnostic as well as a therapeutic procedure. Laparoscopic procedures are minimally invasive, showing better outcomes and improving patient satisfaction and comfort. Another term for laparotomy surgery is abdominal exploration. Surgery usually comes with risk of many infections. Adjuvant or combination therapies are administered to avail better treatment outcomes.

What Is Exploratory Laparotomy Surgery?

Exploratory laparotomy surgery is a surgery that is performed to detect the cause of the discomfort or pain in the abdomen that has not subsided for a longer period. It is a surgery performed under general anesthesia. A single cut is made through the muscle of the abdomen and the skin to view the internal organs. The examination of the exposed organs is done clearly. Any finding that needs a surgical repair is done simultaneously during the laparotomy procedure. In cases where the operation cannot be performed, a second surgery is planned to address the specified issue. After the procedure is completed, the skin and the abdominal muscle wall are sutured and closed.

What Are the Reasons Behind Carrying Out Laparotomy Surgery?

The following are the indications for carrying out laparotomy surgery:

• This surgical procedure is done to investigate abdominal pain.

• To find out the exact reason for the cause of pain as there are many organs in the digestive tract, such as the stomach, intestines, and liver, including the organs of excretion, such as the bladder and kidneys.

• Any bleeding in the gastrointestinal tract or any perforations in the bowel can be pinpointed more precisely.

What Is Drug Therapy for Exploratory Laparotomy Surgery?

When the patient is admitted for the surgical procedure, the drug therapy is given with the following:

1. Antibiotics.

2. Pain medicine.

3. Anti-nausea medicine.

4. Feces softener.

1. Antibiotics - Bacterial infections are treated by antibiotics. A continuous course of antibiotics is prescribed depending on the severity and clinical condition of the patient. Infections can be categorized into three categories:

• Mild Infections - Mild infections are treated precisely using surgical drainage and therapy including a wide range of antibiotics (Ampicillin, Sulbactam, or Cefoxitin).

• Mild-Moderate Infections - Most frequently occurring infections in clinical practice are mild-moderate infections. They are treated using a single drug, which includes antibiotics against anaerobes.

• Severe Infections - This shows the highest degree of infection which needs an aggressive treatment approach with a combination treatment.

Following are the antibiotics used in the drug therapy after exploratory laparotomy surgery:

Clindamycin, Metronidazole - Acting Against Anaerobes.

Clindamycin - It is an antibiotic that can be administered in the form of a capsule or injection. It is either taken orally or as an intramuscular injection.

Metronidazole - Infections in the gastrointestinal tract, reproductive system, and abdominal infections can be treated by Metronidazole. They can be consumed orally in the form of tablets.

Ciprofloxacin, Aminoglycosides - Acting Against Gram-Negative Bacteria.

Ciprofloxacin is used against gram-negative bacteria such as gonorrhea, and pneumonia. Ciprofloxacin can be taken orally as a tablet, or suspension and is given in a single dose.

Penicillins, Cephalosporins - Acting Against Gram-Positive Bacteria.

Penicillins act by preventing the growth of bacteria and killing the bacteria. Amoxicillin, Ampicillin, Ticarcillin, and Nafcillin are a few penicillins.

Glycopeptides - Acting Against MRSA (Methicillin Resistant Staphylococcus Aureus)

Endocarditis and other systemic infections are treated using glycopeptides.

Other drugs used in the drug therapy are listed below:

2. Pain Medicine - Medicine to combat pain is prescribed by the physician. Mild pain also has to be addressed instead of waiting for the pain to aggravate.

3. Anti-Nausea Medicine - Vomitings are prevented by using anti-nausea medication to calm the stomach.

4. Faeces Softener - As the abdominal pain can be due to irregular or decreased bowel movements, stool softeners are administered to prevent constipation.

What Are the Complications of Laparotomy Procedure?

The following are the possible complications of the laparotomy procedure:

During the Surgery:

• Damage to Bowel - Bowel damage or perforation is treated as a medical emergency, as the contents of the bowel can spill out and cause sepsis and can also lead to death.

• Damage to Abdominal Organs - The spleen is the most affected organ, and the injured spleen is removed by a procedure called a splenectomy.

• Incisional Hernia - An extra tissue is formed during the healing which protrudes into the abdomen. Most incisional hernias are not serious. They cannot be treated on their own and need surgical treatment for repair.

After the Surgery:

• Infection - Chances of infection after surgery are higher due to exposure of internal organs to bacteria.

• Hemorrhage (Bleeding) - Bleeding from the surgical wound can occur for three days. In certain cases, it can even occur after a week or so.

• Internal Organs Damage - As there are many important organs located in the abdomen, chances of damage like lacerations are higher.

• Internal Scar Tissue (Adhesions) Formation - Scar tissue formation can occur at the surgical region which can limit the movements involving that particular region.

• Abdominal Pain or Bowel Blockages - Abdominal pain and blockage can happen in the bowel.

What Are the Precautions Taken at Home After Discharge?

Following are the precautions taken at home after the discharge:

Proper rest for at least two weeks. Heavy lifting, pushing, and pulling are to be avoided. Dietary suggestions including prescribed medications are to be followed. Drugs administered at the time of discharge of the patient include antibiotics and pain medicine. When the wound becomes inflamed and starts to pain with a discharge of fluids, this indicates infection and the physician has to be informed.

Conclusion

In the current scenario, death due to intra-abdominal infections has drastically decreased due to the advancements in surgical techniques and thoughtful approaches to antibiotic treatments.

A perfect approach to antibiotics and advanced surgical procedures is the best solution to resolve very severe abdominal infections and eliminate them. Laparotomy is a procedure used to detect the presence of any infections or to identify the main cause of pain. As it is a surgical procedure and involves complications, drugs are used to combat its associated risks.