EXPLORATORY OPERATION(EXPLORATORY LAPAROTOMY)

▲ GENERAL INFORMATION the mouth and throat are sprayed to make themnumb, the patient is given medicine and is put into aThis used to be a very common operation because‘‘twilight sleep.’’ The instrument is inserted throughthere were so few other ways to ‘‘look at’’ organsthe mouth, down the esophagus, past the stomach,inside the abdomen (and even these few were not soand to the duodenum, where the bile duct emptiesgood). Surgeons had to open up the abdomen to exploreits juices. A special tube (thinner than a toothpick) isthe inside.then passed out of the instrument into the bile ducts

‘‘EXPLORATION’’ coming from the liver. Pictures of the bile ducts canbe taken to look for stones or other problems. OftenNow there are a number of ways to explore—or lookthe problems found can be taken care of at the sameinside—the abdomen without actually having to opentime.it up.

• Peritoneal Lavage: This is most often used inA few of these newer methods are the following:persons who have had an injury to the abdomen and• Ultrasound: Harmless sound waves are aimed atoften to other areas as well. Sometimes it is difficultyour abdomen. The sound waves bouncing back (theto know if there is bleeding or infection inside theechoes) from this area are seen as a picture on aabdomen. Although this is an important question,screen. This is a convenient, painless, and harmlessthere may be injuries to other areas of the body thatway to examine organs and tissues inside yourneed prompt attention. Which should be taken careabdomen.of first? A very thin plastic tube is inserted into the• CT Scan (Computed Tomography Scan): Theseabdomen, and through this plastic tube a bottle ofpictures are taken by a special x-ray machine shapedsalt solution is instilled into the abdomen. After alike a huge doughnut. You will lie on the table insideshort while, the salt solution is removed through thethe hole in the ‘‘doughnut.’’ The x-rays are taken assame tube and examined for any red blood cells,very thin slices through any area of the body. Thiswhite blood cells, bacteria, or chemicals. Thismakes it possible to see the fine details in the areaprocedure may provide information about what maybeing examined.be happening inside the abdomen.• MRI (Magnetic Resonance Imaging): No x-raysThese and other modern techniques help doctorsare used with this technique. Instead, magnetic fields

‘‘see’’ inside the abdomen. This does not mean that theand radio waves are used. A computer develops theabdomen does not need to be opened to make thepictures to show organs from several angles. It isdiagnosis and take care of the problem. What it doesespecially valuable for examining blood vessels and mean is the following:nerve tissue.• The abdomen does not always need to be opened to

• PET Scan (Positron-Emission Tomography find out what is wrong.Scan): This is one of the latest and most• Sometimes biopsy and observation not only can makesophisticated ways of looking at tumors. This the diagnosis but also can show that the problemtechnique not only can locate tumors but also can does not require specific care—it will get well byshow how active they are biologically. itself. Or the problem can be taken care of with

• Colonoscopy: This is done with an optical medicine and x-rays rather than with a formalinstrument called a colonoscope. It is smooth, operation.flexible, and as big around as your little finger and • The surgeon can know what is wrong beforehandhas a light at its tip. You will be given medicine that and so can make plans to take care of the problemwill make you feel drowsy during the procedure. The without any surprises. Also, the patient knows whattip of the instrument will be lubricated and then to expect.gently inserted into your anus. It can be used to • Sometimes a laparoscope can be used to both makeinspect your entire large bowel. the diagnosis and to take care of the problem.

• Laparoscopy: This method uses a rigid optical • It can spare a patient with multiple injuries, andinstrument called a laparoscope. It is as big around possible but unknown injuries to the abdomen, anas the tip of your little finger and has a light at its unnecessarily wide opening of the abdomen totip. With the patient asleep, the laparoscope is determine whether anything is actually wrong. Thisinserted into the abdomen through a very small then allows the doctor to take care of the otherincision in the navel so the inside of the abdomen injuries without worrying about missing somethingcan be examined directly. If something suspicious is serious in the abdomen.seen, a tiny piece (a biopsy) can be removed for Now an exploratory abdominal operation can be morelaboratory examination. focused. The surgeon more often knows what is there

• ERCP (Endoscopic Retrograde Choledocho- and what needs to be done. These new techniques andpancreatography). This is an optical instrument (an a number of other associated advances are the reasonsendoscope) that has a light at its tip and is smooth, that abdominal operations are now more appropriate,

safer, and more effective.flexible, and about the size of your little finger. After