Laparotomy and laparoscopic surgery are performed on the abdomen to diagnose peritoneal malignant mesothelioma.
Peritoneal mesothelioma is cancer of the lining of the abdomen. There are approximately 400-600 cases of malignant peritoneal mesothelioma in the United States per year. That figure represents 10-15% of all the cases of malignant mesothelioma diagnosed a year. The peritoneum is the second most frequent site of origin after the pleural lining of the lung. The same risk factor – exposure to asbestos – occurs in both pleural and peritoneal mesothelioma.
Symptoms of malignant peritoneal mesothelioma can include abdominal distension. This occurs in as many as 80% of those diagnosed. Other symptoms of malignant peritoneal mesothelioma include pain, anorexia, dyspnea- shortness of breath and chest pain. There is no one specific symptom of malignant peritoneal mesothelioma and it is often found in women when they are having a medical work-up for another issue. The average time between onset of symptoms and diagnosis is approximately 5 months.
Treatment of malignant peritoneal mesothelioma can include an exploratory laparotomy. Exploratory laparotomy is performed in order for the surgeon to visualize and examine the organs and structures of the abdominal cavity.
There are different reasons to perform an exploratory laparotomy. One of the leading causes is trauma often caused by gunshot wounds, stabbing, or anything that could cause bleeding into the abdominal cavity. Bleeding into the abdominal cavity is considered a medical emergency. By opening the abdominal cavity, the surgeon can visualize the organs, blood vessels, and tissues in the abdominal cavity. Another reason is abdominal pain of unknown etiology. The laparotomy procedure is used to determine the source of the pain enabling the surgeon to visualize the abdominal cavity. Staging of cancer is also a reason for an exploratory laparotomy. The wide incision allows the surgeon to examine the organs and look for evidence of spreading of cancer.
For treatment of peritoneal mesothelioma, the parietal layer covers the abdominal cavity, while the visceral layer surrounds the stomach, liver, and other organs of the abdomen.
Heated intraoperative chemotherapy is administered once the surgeon has removed the visible peritoneal cancer. This chemotherapy fluid circulates throughout the abdomen. Certain mesothelioma centers will leave drains in the abdomen to reinfuse the abdominal area within the next few days following surgery.
The first laparotomy procedure is credited to Dr. Frank Zurfley in 1842. He operated on a patient that had suspected hemorrhaging in the abdomen after trauma. Minimally invasive laparoscopic approach is used more frequently than exploratory laparotomy currently. As the equipment has improved and surgeons have become more experienced with the minimally invasive procedure, laparotomy has been utilized less than before.
After an abdominal laparotomy it is important for the patient to move around. Walking helps the intestines to start working again. Often, patients will have a nasogastric tube in their nose running down to the stomach. This tube drains the stomach and usually is left in place until the patient is able to pass gas. Some of the most common complications of this surgery are infection, incisional hernia and ileus, which is lack of movement of the intestines. This can lead to buildup and potential blockage of food and materials. An ileus can lead to an intestinal obstruction. At that point no food, gas or liquid can get through. Pain can be controlled through epidural or intravenous medications until the patient is able to take medicine by mouth.
Recovery time from a laparotomy is usually 2-6 weeks. Infection is the most common complication. Monitoring for any signs of infection is an important part of the post-op care. Any redness, drainage, separating of the incision line, fever must be reported immediately.
An abdominal laparotomy is a wide incision on your abdomen. It is used for cytoreductive surgery for peritoneal mesothelioma. This procedure combined with heated intra-op chemotherapy, and an experienced surgeon and specialized mesothelioma team has improved the treatment of mesothelioma.
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