Laparotomy and laparoscopy are two similar yet dramatically different surgical procedures. If you’ve landed on this article, you’re trying to figure out one of two things. The first being why your doctor recommended one over the other. The second reason is you’ve recently found out you may have endometriosis and need exploratory surgery to properly diagnose. So, you’re researching different surgeries and treatment options to figure out what’s going to happen to you. And while laparoscopy is the most common surgical procedure for endometriosis. Indeed, there are many cases in which laparotomy is a better choice. So, let’s cut through the confusion and talk about the differences and similarities between laparotomy and laparoscopy.
Defining Both The Laparotomy and Laparoscopy
First things first, let’s get clear on how laparotomy and laparoscopy are defined. Laparotomy is a major surgical procedure involving a vertical incision on the abdomen. Typically from the sternum down to the pelvis. During the procedure, your abdomen is open, providing a clear view of the pelvic organs as well as surrounding structures and organs. Thus allowing the surgeon to diagnose endometriosis and treat it.
In contrast, laparoscopy is a minimally invasive surgical procedure in which small incisions are made on the abdomen. Fiber optic instruments known as a laparoscope is inserted into these incisions to view the pelvic organs. This also allows the surgeon to diagnose and treat endometriosis.
What Makes Laparotomy And Laparoscopy Similar
Both of these surgical procedures are indicated to treat various gynecologic conditions. Furthermore, they are two of the main surgeries associated with endometriosis treatment. Laparotomy and laparoscopy remove adhesions and endometriosis from organs via excision (gold standard treatment) or ablation (outdated treatment). Additionally, they are used for full and partial hysterectomies, removing ovarian cysts, fibroids, and ovary removal.
Laparotomy and laparoscopy have the same risks and complications. Similar complications are infection, excessive bleeding, hernia, damage to internal organs, reaction to anesthesia, abdominal inflammation, and blood clots.
Additionally, they share similar postoperative complications. Common adverse symptoms are severe pain that doesn’t respond to medication, infection around the incision site, constipation that exceeds two days, chest pain, shortness of breath, fainting, nausea, vomiting, and blood clots.
What Makes Laparotomy And Laparoscopy Different
The key differences between laparotomy and laparoscopy are incisions, post-surgery pain, recovery, and hospital stay.
When And Why They’re Indicated
Laparoscopy is the procedure of choice for endometriosis, fibroids, and ovary removal. Surgeons prefer it because it’s minimally invasive and has fewer risks. Yet, there are some instances when a laporatomy is a better option.
A laparotomy may be recommended if imaging tests reveal a large ovarian cyst or endometrioma. Another instance is if the doctor suspects an ovarian cyst is cancerous. Still, in other cases, a laparotomy may be a better option when there are underlying conditions present.
How Incisions Differ
The incision for the laparotomy is a single vertical incision on the abdomen. Typically this causes a more visible scar (as shown in my photo at the beginning of the post). And it can trigger keloid scarring for those prone to them (such as in my case). In contrast, multiple small incisions are made on the abdomen for the laparoscopy. As a result, the risk of scarring is reduced.
Another difference is the laparoscopy has slight irritation around the incision site. And there’s a reduction of infection. However, these incisions don’t require as much care and heal quickly. On the other hand, laparotomy incisions are more involved and require much care. Staples are used for closing the incision, and dressings are used to cover it. The incision must be kept clean and dry to prevent infection and irritation. Usually, you must be cleared by your doctor to resume showers and baths or adhere to certain instructions. Furthermore, it must remain bandaged until your doctor clears you to remove them.
During the recovery process, your doctor will schedule regular appointments to follow up and make sure the incision is healing properly. When your doctor determines the wound has adequately healed, they will remove the staples.
Post-Surgery Pain And Recovery
With laparoscopy, most of the pain and discomfort is caused by the carbon dioxide used to provide better stability and visibility for the surgeon. This pain is commonly felt in the shoulders, back, or abdomen. Typically it decreases within a few days.
However, the laparotomy typically has more pain and a slightly increased risk of infection because of the incision. Doctors typically prescribe pain medication and antibiotics to help decrease pain and infection.
Complications They Don’t Share
They both indeed share very similar complications. Some complications are unique to each procedure. Although incision site infection is associated with both conditions. It’s only with the laparotomy that yellow pus or draining is most common.
As for the laparoscopy, there appears to be an increased risk of heavy vaginal bleeding and heavy menstrual bleeding with the next period.
Major open surgery will require a longer hospital stay post-surgery. Furthermore, the recovery process is longer. Since laparotomy is major surgery, the aforementioned requirements apply. On average, it takes six weeks to recover, and the doctor may have specific restrictions.
Some general restrictions include not lifting anything beyond five pounds, no bending, avoidance of shower and baths until the doctor approves. And, walking around frequently is necessary to help decrease the risk of blood clots.
In contrast, laparoscopy is minimally invasive, so a long hospital stay isn’t required. The only occasion that an extended hospital stay is required is if there are complications. And while there are pain and unpleasant symptoms experienced post-surgery. Generally, the recovery is faster with a person returning to normal in a few days. Depending on each individual’s recovery process, there may be few if any limitations.
Different But Beneficial
Laparotomy and laparoscopy are two different procedures. However, they both treat similar conditions. Additionally, some of the risks and complications are the same. Whereas there are a couple that is exclusive to each procedure.
Laparotomy is a major surgery requiring a longer recovery time, a larger scar, and more pain. On the other hand, the laparoscopy is minimally invasive with a shorter recovery time, less pain, and shorter hospital stay. Additional benefits included a reduced risk of scarring because smaller incisions are administered.
Regardless, both of these procedures help endo patients achieve better health. Although laparoscopy is popular in the endometriosis community. And, there’s much more awareness surrounding it. It’s still important for endometriosis patients to recognize that laparotomy in some cases may be required. If there’s suspicion of cancer, large endometriomas, or other complications, the laparotomy will most likely be the procedure of choice. But, results and treatment remain the same when treating endometriosis no matter which procedure is performed.