Laparotomy is an open surgery performed through an incision in the abdomen.
This surgery enables the surgeon to get a better insight into the critical condition and remove as much tumor as possible.
In the case of ovarian cancer, surgery is staged and this helps ascertain the extent of the tumor's spread.
During the Ovarian cancer laparotomy, if the surgeon finds the tumor has spread; the uterus, fallopian tubes, and omentum (fatty tissues covering intestines), as well as nearby lymph nodes, are also removed leaving no scope of cancer.
As this is a critical surgery, the gynecological oncologist, the treating surgeon will counsel the patient on the type of surgery as well as complications and risks.
In the case of younger women aiming to start a family, post-surgery infertility conditions need to be explained and consented to.
In cases where the patient is with stage III or stage IV ovarian cancer, the chemotherapy is conducted before the surgery, to shrink the tumor.
The pattern is three cycles of chemotherapy, followed by surgery, and then again three cycles of chemotherapy.
Before the surgery, the patient is given a general anesthetic.
In the case of laparotomy, a long vertical cut is done below the navel to the bikini line. Laparotomy is carried out in cases where the doctor is assured of cancer and its spread.
The entire tumor and adjoining organs where the cancer is suspected are removed and the incision is closed.
The laparotomy can be associated with other surgeries depending on how far cancer has spread.
Total hysterectomy and bilateral salpingo-oophorectomy
This procedure includes removing the entire reproductive system along with ovaries like the uterus, the cervix, and both fallopian tubes.
In certain cases where the cancer is detected early and is only on one ovary, the other ovary can be retained to keep the patient fertile.
A sheet of fatty tissues is attached to the bowel and stomach and is called the omentum. Often ovarian cancer spreads to the omentum and it needs to be removed to arrest the spread.
The pelvis region has a large number of lymph nodes and cancer can spread easily through the lymph nodes and therefore it is recommended to remove the lymph nodes.
In case cancer has spread to the bowel, part of the bowel can be removed and until it heals, a new opening called a stoma.
It is done in the abdomen and the waste is collected through this opening into a waste bag, outside the body. This is a temporary procedure.
Chemotherapy is the treatment of cancer with anti-cancer (cytotoxic) drugs. The aim is to destroy cancer cells while causing the least possible damage to normal, healthy cells. Chemotherapy may be used at different times:
In most cases post-surgery, the patient will have to go for chemotherapy to eliminate any living cancerous cells.
The chemotherapy is scheduled at least 2-4 weeks after the laparotomy. Depending on the individual case, the combination of drugs, intensity, and duration of chemotherapy is decided by the doctor.
Post-surgery the patient is shifted to the recovery room and once stabilized is then taken to the hospital room.
As this is a major surgery there will be many tubes and drips attached to the patient.
The patient will experience pain post-surgery and will be monitored and given medications to control the pain.
Wound care is important and the patient can expect slight vaginal bleeding for up to two weeks.
Length of stay
The hospital stay might go between 4-7 days for a laparotomy.
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