What should be the approach for doing laparotomy for intra-abdominal injuries?
Laparotomy by midline incision is the "gold standard" therapy for intra-abdominal injuries. It is definitive, rarely misses an injury, and allows for complete evaluation of the abdomen and retroperitoneum. All patients with hypotension, abdominal wall disruption, or peritonitis need surgical exploration. In addition, the presence of extraluminal, intra-abdominal, or retroperitoneal air on plain radiograph or CT should prompt surgical exploration. Ref: Scalea T.M., Boswell S.A., Baron B.J., Ma O.J. (2011). Chapter 260. Abdominal Trauma. In J.E. Tintinalli, J.S. Stapczynski, D.M. Cline, O.J. Ma, R.K. Cydulka, G.D. Meckler (Eds), Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 7e.
Depends on organ injured
Always midline incision
Always transverse
Depends upon type of injury