In diagnostic laparotomy (most often referred to as an exploratory laparotomy and abbreviated ex-lap), the nature of the disease is unknown, and laparotomy is deemed the best way to identify the cause.
In therapeutic laparotomy, a cause has been identified (e.g. peptic ulcer, colon cancer) and laparotomy is required for its therapy.
Usually, only exploratory laparotomy is considered a stand-alone surgical operation. When a specific operation is already planned, laparotomy is considered merely the first step of the procedure.
Depending on incision placement, laparotomy may give access to any abdominal organ or space, and is the first step in any major diagnostic or therapeutic surgical procedure of these organs, which include:
Midline incisions are particularly favoured in diagnostic laparotomy, as they allow wide access to most of the abdominal cavity.
Cut (incised) the skin in mid line (linea alba)
Cut (incised) subcutaneous tissue
Divide the linea alba (white line of the abdomen)
Pick up peritoneum, confirm that there is no bowel adhesion (intestinal adhesion)
Insert finger beneath the wound to make sure that there is no adhesion
Cut the peritoneum with scissors; operative surgery of (lsmu)
Other common laparotomy incisions include:
Kocher (right subcostal) incision (after Emil Theodor Kocher); appropriate for certain operations on the liver, gallbladder and biliary tract. This shares a name with the Kocher incision used for thyroid surgery: a transverse, slightly curved incision about 2 cm above the sternoclavicular joints;
Davis or Rockey-Davis "muscle-splitting" right lower quadrant incision for appendectomy;
Pfannenstiel incision, a transverse incision below the umbilicus and just above the pubic symphysis. In the classic Pfannenstiel incision, the skin and subcutaneous tissue are incised transversally, but the linea alba is opened vertically. It is the incision of choice for Cesarean section and for abdominal hysterectomy for benign disease. A variation of this incision is the Maylard incision in which the rectus abdominismuscles are sectioned transversally to permit wider access to the pelvis.
Lumbotomy consists of a lumbar incision which permits access to the kidneys (which are retroperitoneal) without entering the peritoneal cavity. It is typically used only for benign renal lesions. It has also been proposed for surgery of the upper urological tract.
^H. J. Pfannenstiel. Ueber die Vortheile des suprasymphysären Fascienquerschnitts für die gynäkologischen Koeliotomien. (Volkmann’s) Sammlung klinischer Vorträge, Leipzig, 1900, n F. 268 (Gynäk. Nr. 97), 1735-1756.
^Giacalone PL, Daures JP, Vignal J, Herisson C, Hedon B, Laffargue F (2002). "Pfannenstiel versus Maylard incision for cesarean delivery: A randomized controlled trial". Obstetrics and gynecology99 (5 Pt 1): 745–50. doi:10.1016/S0029-7844(02)01957-9. PMID11978282.
^Bajpai M, Kumar A, Gupta AK, Pawar DK (2004). "Lumbotomy approach for upper urological tract surgery in children--an analysis of 68 consecutive lumbotomies". European Journal of Pediatric Surgery14 (3): 163–7. doi:10.1055/s-2004-820903. PMID15211405.