Exploratory laparotomy: an OR 101 guide

Reviewed by Rodnie Oro, cath lab charge nurse · Last reviewed: October 2026 · Education only, not medical advice

Exploratory laparotomy in one minute

What it is: open surgery through a cut down the middle of the abdomen to find and treat a serious problem inside.

Who it is for: people with a burst bowel, bleeding, blockage, serious infection or injury inside the abdomen.

Main risks: infection, bleeding, wound breakdown or hernia, slow bowel recovery, needing a stoma, intensive care, death.

Usually: under general anaesthetic, 1–4 hours or more, often 1–2 weeks in hospital.

On this page: What is an exploratory laparotomy? · Who is it for? · When is it done? · Step by step · Recovery · Risks · Kit list · First time in theatre? · FAQ

What is an exploratory laparotomy?

A laparotomy is an open operation through a cut, usually down the midline of the abdomen. "Exploratory" means the surgeon looks at all the organs to find the cause of the problem, then treats it.

Common findings and treatments include:

• a hole (perforation) in the stomach or bowel: repaired or the bowel removed
• a blockage: adhesions released or bowel removed
• bleeding after injury: controlled, sometimes with packing ("damage control")
• infection: washed out

Many are emergencies. The National Emergency Laparotomy Audit (NELA) supports standards of care in UK hospitals.

New to the acronyms? See the Cath Lab Abbreviations A–Z.

Who is it for?

It may be considered for people with:

• a perforated (burst) stomach or bowel
• bowel obstruction not settling
• serious injury to the abdomen (trauma)
• bleeding or infection inside the abdomen
• an unclear serious problem when scans cannot answer it

The decision is made by your surgical team, who will talk through the reasons, the alternatives and the risks with you.

When is it done?

It is often done as an emergency. Before it, you usually have:

• an urgent assessment, blood tests and often a CT scan
• fluids, antibiotics and pain relief, as per centre protocol
• a risk assessment and planning for intensive care if needed
• blood products ready, as per centre protocol
• a chance to ask questions and give consent, if you are well enough

Step by step

1. Getting ready

Team brief and WHO checklist first. The anaesthetic team and ODP give the anaesthetic (usually a rapid-sequence general, as per centre protocol); antibiotics and blood-clot prevention are given as per centre protocol. Large cannulas, an arterial line and a catheter are often placed. The circulating practitioner checks positioning, pressure areas, the diathermy plate and warming. The scrub practitioner sets up the instrument trolley and does the first count. A bowel set and extra packs are opened.

2. Access

A midline cut is made from above to below the belly button, length per surgeon. Self-retaining retractors hold the wound open.

3. Finding and treating the problem

• A. Opening. The abdomen is opened through the midline.
• B. Look everywhere. The surgeon inspects all organs systematically.
• C. Treat the cause. The problem is treated: repair, resection, release of adhesions or control of bleeding.
• D. Wash out. The abdomen is washed out with warm fluid.

In very unwell patients, a short "damage control" operation may be done, with the abdomen packed and left temporarily open for a planned return to theatre.

4. Finishing

The muscle layer is closed with strong sutures, per surgeon, and the skin with sutures or clips. Drains or a stoma may be needed. Many patients go to intensive or high-dependency care. Final counts are confirmed before closure, specimens labelled and checked, and the patient goes to recovery with a full handover.

Recovery and aftercare

• First days: often in intensive or high-dependency care; pain relief, fluids and close monitoring.
• Eating: drinking and eating are restarted as the bowel recovers.
• Walking: physiotherapy and walking as early as possible.
• Going home: often after 1–2 weeks, depending on the cause.
• Activity: no heavy lifting for about 6–12 weeks; ask your team.
• Follow-up: clinic review; some people need further surgery, such as stoma reversal.

Call 999 if you have severe pain, heavy bleeding, breathlessness or collapse. Contact your team or GP if you have a fever, worsening tummy pain or swelling, vomiting, or a wound that becomes red, hot or leaky.

Risks and complications

Your team will explain the risks that apply to you. Possible problems include:

• wound infection or wound breakdown
• bleeding
• collection of pus inside the abdomen
• slow return of bowel function (ileus)
• needing a stoma
• chest infection and blood clots
• hernia at the wound later
• death, especially in very unwell patients

Theatre kit list (printable)

Example kit list

Every theatre has its own protocol, and sizes and doses vary.

• major laparotomy instrument set and bowel set
• self-retaining abdominal retractor
• large packs and warm washout fluid
• suction
• linear staplers and reloads, sizes per device and operator
• strong closure sutures for the muscle layer
• drains and stoma appliance if needed
• temporary abdominal closure kit for damage control, per centre

Procedural steps

• Team brief, WHO sign in; rapid-sequence anaesthesia; lines; catheter; antibiotics as per centre protocol
• Supine position; prep and drape; count (including large packs)
• Midline incision; retractor
• Systematic inspection; control of bleeding or contamination
• Definitive treatment; washout
• Closure (or temporary closure); counts; sign out and handover to intensive care

First time in theatre?

💡 First-time tip

• Know your role. Scrub, circulating, anaesthetic and ODP each have their own checks; ask at the team brief.
• Counts matter. Swabs, needles and instruments are counted before, during and at closure; speak up if one is missing.
• Large packs. Count large packs carefully, especially if some are left in for damage control; record them.
• Blood ready. Know where blood products and the cell salvage machine are, as per centre protocol.
• Warmth. Keep warming devices running; unwell patients cool quickly.

FAQ

Why can't it be done by keyhole?

In emergencies or with complex problems, open surgery gives the fastest and safest access.

Will I have a stoma?

Sometimes. It depends on what is found.

How long is recovery?

Often several weeks to months.

Related guides

• Small bowel resection and adhesiolysis
• Colectomy (large bowel resection)
• Cath Lab Abbreviations A–Z

Sources

All checked on 14 October 2026. Each page's own date is shown where it gives one.

• National Emergency Laparotomy Audit (NELA). nela.org.uk
• StatPearls (NCBI Bookshelf), search: exploratory laparotomy. ncbi.nlm.nih.gov/books
• NHS. Stoma care and surgery: colostomy. nhs.uk/conditions/colostomy
• World Health Organization. Surgical Safety Checklist. who.int

Disclaimer

Education only. This page is for general education for healthcare students, theatre staff and curious readers. It isn't medical advice and doesn't replace advice from your own doctor, surgical team or local unit protocols. Equipment and medicines are described generically. No product or manufacturer is recommended. If you think someone is having a medical emergency, call 999.

Disclosure: I work in the medical device industry. This page is independent education and isn't sponsored or reviewed by any company.

All diagrams on this page are original illustrations created for rodnieoro.com.