General technique Scar from midline incision for<unk>  A vertical cut, or incision, is made in the middle of the abdomen. This midline incision extends from the xiphoid process at the bottom of the chest to the pubic symphysis at the bottom of the pelvis. The fibrous tissue of the linea alba, which separates the right and the left abdominal muscles, serves as a guide for where to cut. After opening the fascia, the abdominal cavity, or peritoneum, is entered. The surgeon then looks for evidence of injury, infection, or disease. In trauma<unk> , any immediate, life-threatening bleeding is first identified and controlled. In these cases, sponges are often packed in the spaces around the liver and the spleen to slow bleeding until a source can be found. This allows the surgeon to focus on one area at a time by removing the sponges from that quadrant. A systematic approach is taken to examining the abdominal organs for disease. The small bowel is "run", or looked at segment by segment, along its entire length from the ligament of Treitz to the terminal ileum. The gastrocolic ligament is incised and the lesser sac is explored, including the posterior stomach and the anterior pancreas. The surfaces of the spleen and the liver also are examined for injury. If being performed for cancer staging, special attention will be paid during the<unk>  to the lymph nodes, which may be biopsied, or removed and assessed with a microscope or other special tests to see whether they contain cancerous cells indicative of cancer spread. If necessary, several other surgical maneuvers or procedures may be performed. Additional maneuvers + Definition Purpose Structures mobilized Structures exposed Mattox maneuver ("left medial visceral rotation") surgical maneuver named for Dr. Kenneth Mattox in which left-sided abdominal organs are mobilized and moved temporarily out of the way to provide access to deeper retroperitoneal left-sided abdominal structures stomach, pancreatic tail, spleen, left kidney, left hemicolon aorta, left iliac vessels, left renal vessels, pelvic vessels Cattell-Braasch maneuver ("right medial visceral rotation") surgical maneuver named for Dr. Richard Cattell and Dr. John Braasch in which right-sided abdominal organs are mobilized and moved temporarily out of the way to provide access to deeper retroperitoneal right-sided abdominal structures duodenum, pancreatic head, right hemicolon inferior vena cava, portal vein, right iliac vessels, right renal vessels Kocher maneuver surgical maneuver named for Dr. Emil Theodor Kocher in which the duodenum and the head of the pancreas are mobilized and moved out of the way to the left to fully inspect the duodenum and the pancreas and to access deeper structures behind them duodenum, pancreatic head aorta, inferior vena cava, posterior duodenum, posterior pancreas Additional procedures Based on where and what injury or disease is identified, one or more additional procedures may be performed during an<unk> , including: *splenectomy, or removal of all or part of the spleen *hepatectomy, or removal of all or part of the liver *pericardial window, in which an opening is made in the sac surrounding the heart *repairs of the vena cava *repairs of the aorta *repairs of the common, external, or internal iliac arteries or common, external, or internal iliac veins *distal pancreatectomy, or removal of the body or the tail of the pancreas *enterotomy and bowel repair or bowel resection *right or left hemicolectomy *pyloric exclusion and gastric diversion, in which gastric secretions are diverted away from the duodenum by closing the pylorus and creating a new connection between the stomach and the small intestine *nephrectomy, or removal of all or part of a kidney *the "trauma Whipple" Depending on the stability of the patient following an<unk> , the abdomen may be sutured back together ("primary closure") or one or more tissue layers may be left open ("open abdomen") to facilitate further non-surgical resuscitation. In cases where the abdomen is left open, a vacuum dressing, a saline bag, or towel clips may be placed to protect the internal organs until the patient is stable enough to return to the operating room for definitive closure.
Exploratory laparotomy
Exploratory surgery
Diagnostic peritoneal lavage
Antral lavage
Abdominal x-ray
Whole bowel irrigation
Lower gastrointestinal series
Peritoneal washing