How long does the postoperative period last? Postoperative period

Everyone knows that recovery from appendicitis, as from other diseases that require surgery, takes some time. The recovery period after appendicitis requires close attention from doctors and efforts on the part of the patient, since during rehabilitation there are many restrictions and recommendations, the implementation of which is extremely important for a successful cure.

After undergoing surgery due to appendicitis, you need to undergo a period of rehabilitation for a speedy recovery and suppression of complications.

Postoperative period and its importance

Acute appendicitis (ICD-10 code, K-35) is a common disease. In some people, it does not become inflamed throughout their lives. Inflammation of the appendix is ​​treated with medication or surgery. After surgery to remove appendicitis, a long recovery is required, neglect of which is fraught with dangerous consequences.

During a hospital stay, care for a patient with appendicitis is provided by medical professionals. Home restoration requires a lot of effort as it is done on your own. If you follow the recommendations of a specialist, your body will return to normal faster and the wounds will heal. Failure to follow the rules after removal of the appendix can lead to separation of the external and internal sutures and complications.

This is a reason to immediately go to the hospital. It is important to try not to move, so it is better to call an ambulance.

As a rule, recovery from appendicitis lasts at least 0.5 months.

Today it is carried out by laparoscopy or abdominal surgery. Laparoscopic intervention is possible if the organ is inflamed, but tissue rupture has not yet occurred. This easy surgical treatment option provides for recovery after removal of appendicitis within 2 weeks, less often - 4. Abdominal surgery is more traumatic, so it may take six months for complete recovery. Only a doctor can say more precisely how much is needed for full recovery. Recovery for young children and adults with excessive body weight is more difficult and longer.

First postoperative days

Rehabilitation after appendicitis begins with the end of surgery. The period until the day the patient is discharged is called postoperative. The first days of care for a patient after an appendectomy are provided by medical staff. After leaving anesthesia, the patient must strictly adhere to medical prescriptions. Anesthesia can affect a person in different ways, so vomiting, chills and other symptoms may occur.

Medical care

The first day, eating is prohibited. Drinking water during the first hours is not recommended. Since the right side hurts, you first need to lie only on your left side. After a day, the patient is allowed to get up, but if the operation was performed laparoscopically, they are helped to get up after 5-6 hours, and it is recommended to immediately walk a little. The incision is treated daily with antiseptic agents. In addition, it is necessary to take antibacterial drugs and other medications prescribed by the doctor. If the patient is concerned about constipation, he is given an enema.

During the first few days, the patient has an elevated body temperature. This is fine. But if the temperature lasts longer than 7 days, you should consult a doctor. It is necessary to monitor how long the right side of the abdomen and the incision site hurt. The abdomen around the wound should not hurt at all. After discharge, the patient is recommended to wear a bandage. The patient is discharged from the hospital 7–10 days after removal of the appendix, after removing the external sutures. This concludes the postoperative period after removal of appendicitis.

Throughout the patient’s stay in the hospital, doctors monitor the following procedures:

• control of physiological recovery parameters;
• detoxification (for example, if there was purulent appendicitis);
• monitoring the patient's condition and symptoms of complications;
• monitoring the condition of the suture (no bleeding).

Some questions

Rehabilitation after removal of appendicitis lasts from one to several months. This is a lot of work on the part of the patient. The patient should know how to behave during this period, whether there are contraindications, what recommendations make recovery easier and faster. It is important to know about the rules of hygiene, nutrition, physical activity and other procedures that the patient encounters daily.

Swimming, pool, sauna

Before the stitch is removed, doctors prohibit showering and swimming. Hygiene can be maintained by washing specific areas. It is better to wipe the abdomen with a wet sponge to prevent water from entering the wound. You should not take a bath or swim for 2 weeks after surgery. After the stitches are removed, you are allowed to shower. The swimming pool after appendicitis is allowed only after the wounds have completely healed, as you need to swim there. Such premature activity can cause wound dehiscence. It is recommended to visit the bathhouse no earlier than every month.

Tanning and solarium

For the first time after an appendectomy, it is not recommended to expose the wound to sunlight and ultraviolet radiation; therefore, it is forbidden to go to a solarium or to places where the scar will be exposed to the sun (for example, the beach). Later, you are allowed to sunbathe, but it should be taken into account that the tan will not be uniform, since the incision site must be covered.

Physical activity

Prevention of most complications includes breathing exercises. Exercise therapy includes simple exercises that are first performed while lying on your back. It is recommended to do the exercises while still in the hospital and continue at home. Wearing a bandage is mandatory only for children and overweight people. This will help prevent the wound from spreading. Several weeks after discharge, if your condition allows, you should start walking. Walking is done at a slow pace. You should avoid playing sports until the scar is completely healed (hardening at the incision site). This requires more than one week. Usually, sports are allowed after one decade, but you can pump up your abs and lift weights no earlier than six months later.

The postoperative period begins immediately after the end of the operation and ends with the patient’s recovery. It is divided into 3 parts:

early - 3-5 days

late - 2-3 weeks

long-term (rehabilitation) - usually from 3 weeks to 2-3 months

Main taskspostoperative period are:

Prevention and treatment of postoperative complications.

Acceleration of regeneration processes.

Rehabilitation of patients.

The early postoperative period is the time when the patient’s body is primarily affected by surgical trauma, the effects of anesthesia and the forced position.

The early postoperative period may be uncomplicated And complicated.

In an uncomplicated course of the postoperative period, the reactive changes that occur in the body are usually moderate and last for 2-3 days. In this case, there is a fever of up to 37.0-37.5 ° C, inhibition of the central nervous system is observed, and there may be moderate leukocytosis and anemia. Therefore, the main task is to correct changes in the body, control the functional state of the main organs and systems.

Therapy for an uncomplicated postoperative period is as follows:

pain management;

correct position in bed (Fowler's position - the head end is raised);

wearing a bandage;

prevention and treatment of respiratory failure;

correction of water-electrolyte metabolism;

balanced diet;

control of the function of the excretory system.

The main complications of the early postoperative period.

I. Complications from the wound:

bleeding,

development of wound infection,

suture dehiscence (eventeration).

Bleeding- the most serious complication, sometimes threatening the patient’s life and requiring repeated surgery. In the postoperative period, to prevent bleeding, place an ice pack or a load of sand on the wound. For timely diagnosis, monitor pulse rate, blood pressure, and red blood counts.

Development of wound infection can occur in the form of the formation of infiltrates, wound suppuration, or the development of a more serious complication - sepsis. Therefore, it is imperative to bandage patients the next day after surgery. To remove the dressing material, always soak the wound with sanguineous discharge, treat the edges of the wound with an antiseptic and apply a protective aseptic bandage. After this, the bandage is changed every 3 days when it gets wet. According to indications, UHF therapy is prescribed to the surgical site (infiltrates) or antibiotic therapy. It is necessary to monitor the portal functioning of drainages.

Suture dehiscence (eventeration) most dangerous after abdominal surgery. It may be associated with technical errors when suturing the wound (the edges of the peritoneum or aponeurosis are closely captured in the suture), as well as with a significant increase in intra-abdominal pressure (with peritonitis, pneumonia with severe cough syndrome) or with the development of infection in the wound. To prevent suture dehiscence during repeated operations and with a high risk of developing this complication, suturing the wound of the anterior abdominal wall with buttons or tubes is used.

II. The main complications of the nervous system: in the early postoperative period there are pain, shock, sleep and mental disorders.

Elimination of pain in the postoperative period is given exceptional importance. Painful sensations can reflexively lead to disruption of the cardiovascular system, respiratory system, gastrointestinal tract, and urinary organs.

Pain is controlled by prescribing analgesics (promedol, omnopon, morphine). It must be emphasized that unreasonable long-term use of drugs in this group can lead to the development of a painful addiction to them - drug addiction. This is especially true in our time. In addition to analgesics, the clinic uses long-term epidural anesthesia. It is especially effective after abdominal surgery; within 5-6 days makes it possible to sharply reduce pain in the area of ​​surgery and eliminate a pair of intestines in the shortest possible time (1% trimecaine solution, 2% lidocaine solution).

Eliminating pain, combating intoxication and excessive stimulation of the neuropsychic sphere are the prevention of such complications from the nervous system as postoperative sleep and mental disorders. Postoperative psychoses often develop in weakened, exhausted patients (homeless people, drug addicts). It must be emphasized that patients with postoperative psychosis require constant supervision. Treatment is carried out jointly with a psychiatrist.

Let's look at an example: A patient with destructive pancreatitis developed psychosis in the early postoperative period. He jumped out of the intensive care unit window.

III. Complications from the cardiovascular system can occur primarily as a result of weakness of cardiac activity, and secondarily as a result of the development of shock, anemia, severe intoxication.

The development of these complications is usually associated with concomitant diseases, so their prevention is largely determined by the treatment of concomitant pathology. The rational use of cardiac glycosides, glucocorticoids, sometimes vasopressants (dopamine), compensation of blood loss, complete oxygenation of the blood, combating intoxication and other measures taken taking into account the individual characteristics of each patient make it possible in most cases to cope with this severe complication of the postoperative period.

An important issue is the prevention of thromboembolic complications, the most common of which is pulmonary embolism- a serious complication, which is one of the common causes of death in the early postoperative period. The development of thrombosis after surgery is due to slow blood flow (especially in the veins of the lower extremities and pelvis), increased blood viscosity, water and electrolyte imbalance, unstable hemodynamics and activation of the coagulation system due to intraoperative tissue damage. The risk of pulmonary embolism is especially high in elderly obese patients with concomitant pathology of the cardiovascular system, the presence of varicose veins of the lower extremities and a history of thrombophlebitis.

Principles for the prevention of thromboembolic complications:

early activation of patients, active management in the postoperative period;

impact on a possible source (for example, treatment of thrombophlebitis);

ensuring stable dynamics (control of blood pressure, pulse);

correction of water and electrolyte balance with a tendency to hemodilution;

the use of disaggregants and other agents that improve the rheological properties of blood (reopolyglucin, trental, neoton);

the use of direct (heparin, fraxiparin, streptokinase) and indirect anticoagulants (syncumar, pelentan, aescusin, phenylin, dicoumarin, neodicoumarin);

bandaging the lower extremities in patients with varicose veins.

IV. Among the postoperative complications from the respiratory system the most common are tracheobronchitis, pneumonia, atelectasis, and pleurisy. But the most dangerous complication is development of acute respiratory failure, associated primarily with the consequences of anesthesia.

That's why the main measures for the prevention and treatment of respiratory complications are:

early activation of patients,

adequate position in bed with the head end elevated

(Fowler's position),

breathing exercises,

combating hypoventilation of the lungs and improving the drainage function of the tracheobronchial tree (inhalation of humidified oxygen,

cupping, mustard plasters, massage, physiotherapy),

thinning sputum and using expectorants,

prescribing antibiotics and sulfa drugs taking into account sensitivity,

sanitation of the tracheobronchial tree in seriously ill patients (through an endotracheal tube during prolonged mechanical ventilation or through a microtracheostomy during spontaneous breathing)

Analysis of inhalers and oxygen system.

V. Complications from the abdominal cavity in the postoperative period are quite severe and varied. Among them, peritonitis, adhesive intestinal obstruction, and gastrointestinal paresis occupy a special place. Attention is drawn to the collection of information when examining the abdominal cavity: examination of the tongue, examination, palpation, percussion, auscultation of the abdomen; digital examination of the rectum. The particular importance in the diagnosis of peritonitis is emphasized in such symptoms as hiccups, vomiting, dry tongue, muscle tension in the anterior abdominal wall, bloating, weakened or absent peristalsis, the presence of free fluid in the abdominal cavity, and the appearance of the Shchetkin-Blumberg symptom.

The most common complication is the development paralytic obstruction (intestinal paresis). Intestinal paresis significantly disrupts the digestive processes, and not only them. An increase in intra-abdominal pressure leads to a high position of the diaphragm, impaired ventilation of the lungs and heart activity; In addition, there is a redistribution of fluid in the body, absorption of toxic substances from the intestinal lumen with the development of severe intoxication of the body.

Basics of preventing intestinal paresislaid down for operations:

careful handling of fabrics;

minimal infection of the abdominal cavity (use of tampons);

careful hemostasis;

novocaine blockade of the mesenteric root at the end of the operation.

Principles of prevention and control of paresis after surgery:

early activation of patients wearing a bandage;

rational diet (small convenient portions);

adequate gastric drainage;

insertion of a gas outlet tube;

stimulation of motility of the gastrointestinal tract (proserin 0.05% - 1.0 ml subcutaneously; 40-60 ml of hypertonic solution IV slowly drip; cerucal 2.0 ml IM; cleansing or hypertonic enema);

2-sided novocaine perinephric blockade or epidural blockade;

In gynecology, in the treatment of uterine bleeding in recent years, various conservative methods of influencing the uterus have been used, for example, hysteroresectoscopic removal of the myomatous node and endometrial ablation, thermal ablation of the endometrium, hormonal suppression of bleeding. However, they often turn out to be ineffective. In this regard, surgery to remove the uterus (hysterectomy), performed both planned and emergency, remains one of the most common abdominal interventions and ranks second after appendectomy.

The frequency of this operation in the total number of gynecological surgical interventions in the abdominal cavity is 25-38%, with the average age of women operated on for gynecological diseases being 40.5 years and for obstetric complications - 35 years. Unfortunately, instead of trying conservative treatment, among many gynecologists there is a tendency to recommend that a woman with fibroids have her uterus removed after 40 years, citing the fact that her reproductive function has already been realized and the organ no longer performs any function.

Indications for hysterectomy

Indications for hysterectomy are:

• Multiple uterine fibroids or a single one more than 12 weeks in size with a tendency to rapid growth, accompanied by repeated, heavy, prolonged uterine bleeding.
• The presence of fibroids in women over 50 years of age. Although they are not prone to malignancy, cancer develops much more often against their background. Therefore, removal of the uterus after 50 years, according to many authors, is desirable in order to prevent the development of cancer. However, such an operation at approximately this age is almost always associated with subsequent severe psycho-emotional and vegetative-vascular disorders as a manifestation of post-hysterectomy syndrome.
• Necrosis of myomatous node.
• with a high risk of torsion on the stem.
• , growing into the myometrium.
• Widespread polyposis and constant heavy menstruation, complicated by anemia.
• and 3-4 degrees.
• , or ovaries and associated radiation therapy. Most often, the removal of the uterus and ovaries after 60 years is carried out specifically for cancer. During this age period, surgery contributes to a more pronounced development of osteoporosis and a more severe course of somatic pathology.
• Prolapse of the uterus of 3-4 degrees or its complete prolapse.
• Chronic pelvic pain that cannot be treated with other methods.
• Uterine rupture during pregnancy and childbirth, placenta accreta, development of consumption coagulopathy during childbirth, purulent.
• Uncompensated hypotension of the uterus during childbirth or in the immediate postpartum period, accompanied by heavy bleeding.
• Gender change.

Although the technical performance of hysterectomy has improved greatly, this method of treatment still remains technically challenging and is characterized by frequent complications during and after surgery. Complications include damage to the intestines, bladder, ureters, the formation of extensive hematomas in the parametrial area, bleeding, and others.

In addition, there are also frequent consequences of hysterectomy for the body, such as:

• long-term recovery of intestinal function after surgery;
• development (menopause after removal of the uterus) is the most common negative consequence;
• development or more severe course of endocrine and metabolic and immune disorders, coronary heart disease, hypertension, neuropsychiatric disorders, osteoporosis.

In this regard, an individual approach in choosing the volume and type of surgical intervention is of great importance.

Types and methods of hysterectomy



Depending on the volume of the operation, the following types are distinguished:

1. Subtotal, or amputation - removal of the uterus without or with appendages, but preserving the cervix.
2. Total, or hysterectomy - removal of the body and cervix with or without appendages.
3. Panhysterectomy - removal of the uterus and ovaries with fallopian tubes.
4. Radical - panhysterectomy in combination with resection of the upper 1/3 of the vagina, with removal of part of the omentum, as well as the surrounding pelvic tissue and regional lymph nodes.



Currently, abdominal surgery to remove the uterus is carried out, depending on the access option, in the following ways:

• abdominal, or laparotomy (a midline incision in the tissues of the anterior abdominal wall from the umbilical to the suprapubic region or a transverse incision above the pubis);
• vaginal (removal of the uterus through the vagina);
• laparoscopic (through punctures);
• combined.



Laparotomy (a) and laparoscopic (b) access options for hysterectomy surgery

Abdominal access method

It has been used most often and for a very long time. It is about 65% when performing operations of this type, in Sweden - 95%, in the USA - 70%, in the UK - 95%. The main advantage of the method is the possibility of performing surgical intervention under any conditions - both during planned and in case of emergency surgery, as well as in the presence of other (extragenital) pathology.

At the same time, the laparotomy method also has a large number of disadvantages. The main ones are the serious traumatic nature of the operation itself, a long hospital stay after the operation (up to 1–2 weeks), prolonged rehabilitation and unsatisfactory cosmetic consequences.

The postoperative period, both immediate and long-term, is also characterized by a high incidence of complications:

• long-term physical and psychological recovery after hysterectomy;
• adhesive disease develops more often;
• it takes a long time for intestinal function to be restored and the lower abdomen hurts;
• high, compared to other types of access, the likelihood of infection and increased temperature;

Mortality with laparotomy access per 10,000 operations averages 6.7-8.6 people.

Vaginal removal

It is another traditional access used for hysterectomy. It is carried out through a small radial dissection of the vaginal mucosa in its upper parts (at the level of the fornix) - posterior and possibly anterior colpotomy.

The undeniable advantages of this access are:

• significantly less trauma and the number of complications during surgery compared to the abdominal method;
• minimal blood loss;
• short duration of pain and better health after surgery;
• rapid activation of the woman and rapid restoration of intestinal function;
• short period of hospital stay (3-5 days);
• good cosmetic result, due to the absence of an incision in the skin of the anterior abdominal wall, which allows the woman to hide the fact of surgical intervention from her partner.

The recovery period with the vaginal method is much shorter. In addition, the frequency of complications in the immediate postoperative period is low and there are no complications in the late postoperative period, and mortality is on average 3 times less than with abdominal access.

At the same time, vaginal hysterectomy also has a number of significant disadvantages:

• the lack of a sufficient area of ​​the surgical field for visual inspection of the abdominal cavity and manipulation, which significantly complicates the complete removal of the uterus for endometriosis and cancer, due to the technical difficulty of detecting endometriotic foci and tumor boundaries;
• high risk of intraoperative complications in terms of injury to blood vessels, bladder and rectum;
• difficulties in stopping bleeding;
• the presence of relative contraindications, which include, in addition to endometriosis and cancer, significant tumor sizes and previous operations on the abdominal organs, especially on the lower organs, which can lead to changes in the anatomical location of the pelvic organs;
• technical difficulties associated with uterine retraction in obesity, adhesions and in nulliparous women.

Due to such restrictions, in Russia vaginal access is used mainly for operations for prolapse or prolapse of an organ, as well as for gender reassignment.

Laparoscopic access

In recent years, it has become increasingly popular for any gynecological operations in the pelvis, including hysterectomy. Its benefits are largely identical to the vaginal approach. These include a low degree of trauma with a satisfactory cosmetic effect, the possibility of cutting adhesions under visual control, a short recovery period in the hospital (no more than 5 days), a low incidence of complications in the immediate and their absence in the long-term postoperative period.

However, there are still risks of such intraoperative complications as the possibility of damage to the ureters and bladder, blood vessels and large intestine. The disadvantage is also the limitations associated with the oncological process and the large size of the tumor formation, as well as with extragenital pathology in the form of even compensated cardiac and respiratory failure.

Combined method or assisted vaginal hysterectomy

It involves the simultaneous use of vaginal and laparoscopic approaches. The method allows you to eliminate the important disadvantages of each of these two methods and perform surgical intervention in women with the presence of:

• endometriosis;
• adhesions in the pelvis;
• pathological processes in the fallopian tubes and ovaries;
• myomatous nodes of significant size;
• history of surgical interventions on the abdominal organs, especially the pelvis;
• difficult uterine descent, including nulliparous women.

The main relative contraindications forcing preference for laparotomy access are:

1. Common foci of endometriosis, especially retrocervical with growth into the wall of the rectum.
2. Pronounced adhesive process, causing difficulty in cutting adhesions when using laparoscopic techniques.
3. Volumetric formations of the ovaries, the malignant nature of which cannot be reliably excluded.

Preparing for surgery



The preparatory period for planned surgical intervention consists of conducting possible examinations at the prehospital stage - clinical and biochemical blood tests, urine tests, coagulogram, determination of blood group and Rh factor, studies for the presence of antibodies to hepatitis viruses and sexually transmitted infectious agents, including including syphilis and HIV infection, ultrasound, chest fluorography and ECG, bacteriological and cytological examination of smears from the genital tract, extended colposcopy.

In the hospital, if necessary, additional, separate, repeated ultrasound, MRI, sigmoidoscopy and other studies are carried out.

1-2 weeks before surgery, if there is a risk of complications in the form of thrombosis and thromboebolism (varicose veins, pulmonary and cardiovascular diseases, excess body weight, etc.), a consultation with specialized specialists and the use of appropriate medications, as well as rheological agents and antiplatelet agents.

In addition, in order to prevent or reduce the severity of symptoms of post-hysterectomy syndrome, which develops after removal of the uterus in an average of 90% of women under 60 years of age (mostly) and has varying degrees of severity, surgical intervention is planned for the first phase of the menstrual cycle (if any) .

1-2 weeks before the removal of the uterus, psychotherapeutic procedures are carried out in the form of 5-6 conversations with a psychotherapist or psychologist, aimed at reducing the feeling of uncertainty, the unknown and fear of the operation and its consequences. Phytotherapeutic, homeopathic and other sedatives are prescribed, concomitant gynecological pathology is treated, and cessation of smoking and drinking alcoholic beverages is recommended.

These measures can significantly ease the course of the postoperative period and reduce the severity of psychosomatic and vegetative manifestations provoked by the operation.

In the hospital on the evening before the operation, food should be excluded, only liquids are allowed - loosely brewed tea and still water. In the evening, a laxative and a cleansing enema are prescribed, and a sedative is taken before bedtime. On the morning of the operation, the intake of any liquid is prohibited, the ingestion of any medications is discontinued, and the cleansing enema is repeated.

Before the operation, compression tights and stockings are put on, or the lower extremities are bandaged with elastic bandages, which remain until the woman is fully activated after the operation. This is necessary in order to improve the outflow of venous blood from the veins of the lower extremities and prevent thrombophlebitis and thromboembolism.

Providing adequate anesthesia during surgery is also important. The choice of the type of anesthesia is carried out by the anesthesiologist, depending on the expected volume of the operation, its duration, concomitant diseases, the possibility of bleeding, etc., as well as in agreement with the operating surgeon and taking into account the wishes of the patient.

Anesthesia for hysterectomy can be general endotracheal combined with the use of muscle relaxants, as well as its combination (at the discretion of the anesthesiologist) with epidural analgesia. In addition, it is possible to use epidural anesthesia (without general anesthesia) in combination with intravenous drug sedation. Installation of a catheter in the epidural space can be prolonged and used for postoperative pain relief and faster restoration of bowel function.

The principle of the operation technique

Preference is given to laparoscopic or assisted vaginal subtotal or total hysterectomy with preservation of the appendages on at least one side (if possible), which, among other advantages, helps reduce the severity of posthysterectomy syndrome.

How is the operation performed?

Surgical intervention with a combined approach consists of 3 stages - two laparoscopic and vaginal.

The first stage is:

• introduction into the abdominal cavity (after gas insufflation into it) through small incisions of manipulators and a laparoscope containing a lighting system and a video camera;
• performing laparoscopic diagnostics;
• separation of existing adhesions and isolation of the ureters, if necessary;
• application of ligatures and intersection of round uterine ligaments;
• mobilization (release) of the bladder;
• the imposition of ligatures and the intersection of the fallopian tubes and the uterine ligaments or the removal of the ovaries and fallopian tubes.

The second stage consists of:

• dissection of the anterior vaginal wall;
• intersection of the vesicouterine ligaments after displacement of the bladder;
• making an incision in the mucous membrane of the posterior vaginal wall and applying hemostatic sutures to it and to the peritoneum;
• applying ligatures to the uterosacral and cardinal ligaments, as well as to the vessels of the uterus, with subsequent intersection of these structures;
• bringing the uterus into the wound area and cutting it off or dividing it into fragments (if the volume is large) and removing them.
• suturing the stumps and the vaginal mucosa.

At the third stage, laparoscopic control is performed again, during which small bleeding vessels (if any) are ligated and the pelvic cavity is drained.

How long does hysterectomy surgery take?

This depends on the method of access, the type of hysterectomy and the extent of surgery, the presence of adhesions, the size of the uterus and many other factors. But the average duration of the entire operation is usually 1-3 hours.

The main technical principles for removing the uterus using laparotomy and laparoscopic approaches are the same. The main difference is that in the first case, the uterus with or without appendages is removed through an incision in the abdominal wall, and in the second, the uterus is divided into fragments in the abdominal cavity using an electromechanical instrument (morcellator), which are then removed through a laparoscopic tube (tube ).

Rehabilitation period



Moderate and slight bleeding after removal of the uterus is possible for no more than 2 weeks. To prevent infectious complications, antibiotics are prescribed.

In the first days after surgery, bowel dysfunction almost always develops, mainly associated with pain and low physical activity. Therefore, the fight against pain, especially in the first day, is of great importance. For these purposes, injectable non-narcotic analgesic drugs are regularly administered. Prolonged epidural analgesia has a good analgesic effect and improves intestinal motility.

In the first 1-1.5 days, physiotherapeutic procedures, physical therapy and early activation of women are carried out - by the end of the first or at the beginning of the second day they are recommended to get out of bed and move around the department. 3-4 hours after the operation, in the absence of nausea and vomiting, it is allowed to drink still water and “weak” tea in small quantities, and from the second day - to eat food.

The diet should include easily digestible foods and dishes - soups with chopped vegetables and grated cereals, fermented milk products, boiled low-fat fish and meat. Foods and dishes rich in fiber, fatty fish and meats (pork, lamb), flour and confectionery products, including rye bread (wheat bread is allowed on the 3rd - 4th day in limited quantities), chocolate are excluded. From the 5th – 6th day the 15th (general) table is allowed.

One of the negative consequences of any abdominal surgery is the adhesive process. It most often occurs without any clinical manifestations, but can sometimes cause serious complications. The main pathological symptoms of adhesions after hysterectomy are chronic pelvic pain and, more seriously, adhesive disease.

The latter can occur in the form of chronic or acute adhesive intestinal obstruction due to disruption of the passage of feces through the large intestine. In the first case, it is manifested by periodic cramping pain, gas retention and frequent constipation, moderate bloating. This condition can be resolved with conservative methods, but often requires elective surgical treatment.

Acute intestinal obstruction is accompanied by cramping pain and bloating, lack of stool and flatus, nausea and repeated vomiting, dehydration, tachycardia and initially an increase and then a decrease in blood pressure, a decrease in the amount of urine, etc. In case of acute adhesive intestinal obstruction, emergency resolution is necessary through surgical treatment and intensive care. Surgical treatment consists of cutting adhesions and, often, intestinal resection.

Due to the weakening of the muscles of the anterior abdominal wall after any surgical intervention in the abdominal cavity, the use of a special gynecological bandage is recommended.

How long to wear the bandage after hysterectomy?

Wearing a bandage at a young age is necessary for 2 - 3 weeks, and after 45-50 years and with poorly developed abdominal muscles - up to 2 months.

It promotes faster healing of wounds, reduces pain, improves intestinal function, and reduces the likelihood of hernia formation. The bandage is used only during the daytime, and later - during long walking or moderate physical activity.

Since after the operation the anatomical location of the pelvic organs changes, and the tone and elasticity of the pelvic floor muscles are lost, consequences such as prolapse of the pelvic organs are possible. This leads to constant constipation, urinary incontinence, deterioration of sex life, vaginal prolapse and also to the development of adhesions.

In order to prevent these phenomena, it is recommended to strengthen and increase the tone of the muscles of the pelvic floor. They can be felt by stopping urination or defecation, or by trying to squeeze a finger inserted into the vagina with its walls. The exercises are based on a similar compression of the pelvic floor muscles for 5-30 seconds, followed by their relaxation for the same duration. Each exercise is repeated in 3 approaches, 10 times each.

A set of exercises is performed in different starting positions:

1. The legs are set shoulder-width apart, and the hands are on the buttocks, as if supporting the latter.
2. In a kneeling position, tilt your body towards the floor and rest your head on your arms bent at the elbows.
3. Lie on your stomach, put your head on your bent arms and bend one leg at the knee joint.
4. Lie on your back, bend your legs at the knee joints and spread your knees to the sides so that your heels rest on the floor. Place one hand under the buttock, the other on the lower abdomen. While squeezing the pelvic floor muscles, pull your arms up slightly.
5. Position - sitting on the floor with crossed legs.
6. Place your feet slightly wider than your shoulders and place your straightened arms on your knees. The back is straight.

In all starting positions, squeeze the pelvic floor muscles inward and upward, followed by relaxation.

Sexual life after hysterectomy



In the first two months, it is recommended to abstain from sexual intercourse to avoid infection and other postoperative complications. At the same time, regardless of them, removal of the uterus, especially during reproductive age, in itself very often becomes the cause of a significant decrease in the quality of life due to the development of hormonal, metabolic, psychoneurotic, autonomic and vascular disorders. They are interconnected, aggravate each other and are reflected directly on sexual life, which, in turn, increases the degree of their severity.

The frequency of these disorders especially depends on the volume of the operation performed and, last but not least, on the quality of the preparation for it, the management of the postoperative period and treatment in the longer term. Anxiety-depressive syndrome, which occurs in stages, is noted in every third woman who has undergone hysterectomy. The timing of its maximum manifestation is the early postoperative period, the next 3 months after it and 12 months after the operation.

Removal of the uterus, especially total with unilateral, and even more so with bilateral removal of the appendages, as well as carried out in the second phase of the menstrual cycle, leads to a significant and rapid decrease in the content of progesterone and estradiol in the blood in more than 65% of women. The most pronounced disorders of the synthesis and secretion of sex hormones are detected by the seventh day after surgery. The restoration of these disorders, if at least one ovary was preserved, is observed only after 3 or more months.

In addition, due to hormonal disorders, not only does libido decrease, but many women (every 4 to 6 women) develop atrophy processes in the vaginal mucosa, which leads to dryness and urogenital disorders. This also adversely affects sex life.

What medications should be taken to reduce the severity of negative consequences and improve the quality of life?

Considering the staged nature of the disorders, it is advisable to use sedatives, antipsychotic drugs, and antidepressants in the first six months. In the future, their use should be continued, but in intermittent courses.

For preventive purposes, they should be prescribed during the most likely periods of the year for exacerbations of the pathological process - in autumn and spring. In addition, in order to prevent the manifestations or reduce the severity of post-hysterectomy syndrome, in many cases, especially after ovarian hysterectomy, it is necessary to use hormone replacement therapy.

All drugs, their dosages and duration of treatment courses should be determined only by a doctor of the appropriate profile (gynecologist, psychotherapist, therapist) or together with other specialists.

Surgical excision of a spinal hernia is considered the most extreme method of treating such a pathology, which is why many are interested in how long the postoperative period lasts after surgery for a spinal hernia and how complex and dangerous it is. The operation is indicated only if conservative methods do not bring the required result or if the patient has strict contraindications for taking medications.

In addition, there are certain indications for the operation, in particular the following:

• sharp and constant pain;
• compression of nerve endings;
• disruption of the spinal cord;
• risk of paralysis.

The operation to excise a herniated disc is quite complex and there is a high risk of complications, however, in some cases, only surgical removal of the bulging disc will help relieve pain and return full movements. The success of spinal surgery depends not only on the manipulations performed, but also on the correctness of the rehabilitation.

Cartilaginous discs running between the vertebrae allow movement. When there are problems and injuries to the discs, which often occurs with osteochondrosis, they burst and the central part goes beyond the intervertebral space. In this case, a hernia forms, which compresses the nerve endings and provokes severe pain and impaired movement.



If the changes that occur are quite pronounced and do not respond to conservative therapy, then surgical intervention is performed. A spinal hernia is removed using modern, low-traumatic techniques, without significant incisions or damage to soft tissue. In particular, the following is carried out:

• endoscopic excision;
• laser vaporization;
• plastic surgery to strengthen the vertebrae.

Laser therapy is considered the most preferred method, since it provides the most effective and gentle effect that helps eliminate the hernia. In addition, such surgical intervention has much less negative consequences. It is also possible to quickly restore damaged cartilage.

The main role of restorative procedures

Mandatory rehabilitation after removal of a hernia is indicated, which helps to quickly return to normal life and improve motor activity. After surgery, the height of the intervertebral disc decreases, thereby increasing the load on the joints and adjacent vertebrae.

The recovery period takes 4-7 months and during this period certain changes may occur in various parts of the spine, and there is also a high probability of relapses.

Important! The process of recovery and improvement of well-being largely depends on the correct approach to rehabilitation measures.

Rehabilitation after surgery to remove a hernia involves several stages and constant work to strengthen the muscles and improve the mobility of the spine.

Early postoperative period

The postoperative period after removal of a spinal hernia is divided into several different stages. The initial stage of recovery lasts literally 2 weeks from the date of surgery. During this time, the wounds heal completely, and painful manifestations and swelling disappear.

The patient is advised to use painkillers and anti-inflammatory medications, as well as moderate exercise. Usually, after the operation, patients begin to move independently on the 2nd day and do breathing exercises, as well as develop their limbs.

It is allowed to stand up only if the back muscles are supported by an elastic, durable corset. If necessary, drug therapy may be prescribed.

Important! After surgery, standing up without a corset is strictly prohibited, even for a short time, as awkward and sudden movements can lead to negative consequences.

Adaptation period after discharge

After surgery to remove a hernia, the patient is transferred to home treatment for literally 3-4 days. A sharp change in the situation certainly requires compliance with certain restrictions and rules, namely:

• You must wear a corset;
• avoid sudden movements;
• do not sit down for 2 months.

A month after the operation, you need to add a set of special restorative and strengthening exercises for the back muscle corset to the exercises. If necessary, physical therapy can be performed, but only as prescribed by a doctor.

Important! During this period, it is strictly forbidden to be excessively active and use gymnastics on your own without consulting a doctor.

A full course of rehabilitation measures can begin as early as 2 months after the operation, and it implies a complex that includes gymnastics, physiotherapy, massage and sanatorium treatment.

Physiotherapy

Even if no negative consequences are observed after the hernia excision operation, and the recovery period is actively underway, exercise therapy can be performed no earlier than 2 months later. The set of exercises must be selected by the doctor, taking into account all available indications and contraindications.

Basically, during this period, many exercises to strengthen the back muscles are performed while lying on the floor, so you first need to prepare a fairly soft mat. Classes must be done daily, as this is the only way to achieve good results.

Massage

Massage is included in the complex of therapy no earlier than 2 months after discharge from the hospital, and the type of massage procedures must be gentle, warm the muscles and improve blood circulation in the back area. Massage should only be performed by a highly qualified specialist.

When performing a massage, forceful techniques are contraindicated, since there will be no benefit from manual therapy, but rather bad consequences may occur.

Physiotherapy

Spinal surgery to remove a hernia is quite complex, which is why it takes quite a long time for a complete recovery. Physiotherapy helps to cope with pain and promotes faster recovery. Physiotherapeutic procedures can be prescribed at any time at the discretion of the doctor.

Physiotherapy helps:

• eliminate swelling;
• improve blood circulation;
• relieve spasm;
• reduce swelling.

When conducting physiotherapy, a variety of procedures are used, in particular, such as ultrasound, laser exposure, iontophoresis with medications, pulsed currents and much more. All physiotherapeutic procedures are carried out only after a doctor’s prescription.

Diet therapy

After hernia surgery, following a special diet is indicated. In the first days, consumption of easily digestible foods containing a large amount of fiber is indicated.

Subsequently, you need to follow a low-calorie diet. You can consume any food, however, in moderation, so as not to provoke weight gain, as this can be an additional burden on the spine.

A well-chosen program of rehabilitation therapy, carried out for at least six months, will consolidate the results of a successful operation.

Any surgical operation is a serious intervention in the body, and you should not expect that after it everything will be “the same as before.” Even if the surgeon who performed the operation is a real medical genius and everything went well, rehabilitation is necessary to restore the strength and functions of the body.

Rehabilitation after surgery: is it really necessary?

“Why do we need rehabilitation after surgery at all? Everything will heal, and the body will recover itself,” - this is, unfortunately, what many people in our country think. But it should be borne in mind that in a weakened body, the ability to self-heal is reduced. Some operations, in particular on the joints and spine, require mandatory rehabilitation measures, otherwise there is a risk that the person will never return to their usual way of life. In addition, without rehabilitation after surgery, there is a high risk of developing complications caused by prolonged immobility. And not only physical - such as muscle atrophy and bedsores, as well as pneumonia caused by congestion - but also psychological. A person who until recently could move and take care of himself finds himself confined to a hospital bed. This is a very difficult situation, and the task of rehabilitation is to return the person to both good health and mental comfort.

Modern rehabilitation involves not only the restoration of motor functions, but also the relief of pain.

Stages, timing and methods of postoperative rehabilitation

When should postoperative rehabilitation begin? The answer is simple - the sooner the better. In fact, effective rehabilitation should begin immediately after the end of the operation and continue until an acceptable result is achieved.

The first stage of rehabilitation after surgery called immobilization. It lasts from the moment the operation is completed until the cast or stitches are removed. The duration of this period depends on what kind of surgical intervention the person underwent, but usually does not exceed 10–14 days. At this stage, rehabilitation measures include breathing exercises to prevent pneumonia, preparing the patient for physical therapy exercises and the exercises themselves. As a rule, they are very simple and at first represent only weak muscle contractions, but as the condition improves, the exercises become more complex.

From 3–4 days after surgery, physiotherapy is indicated - UHF therapy, electrical stimulation and other methods.

Second phase , post-immobilization, begins after removal of the cast or sutures and lasts up to 3 months. Now much attention is paid to increasing range of motion, strengthening muscles, and reducing pain. The basis of rehabilitation measures during this period are physical therapy and physiotherapy.

Post-immobilization period divided into two stages: inpatient and outpatient . This is due to the fact that rehabilitation measures must be continued after discharge from the hospital.

Stationary stage involves intensive recovery measures, as the patient must leave the hospital as soon as possible. At this stage, the rehabilitation complex includes physical therapy, classes on special simulators,, if possible, exercises in the pool, as well as independent exercises in the ward. Physiotherapy also plays an important role, especially its varieties such as massage, electrophoresis, and ultrasound treatment (UVT).

Outpatient stage is also necessary, because without maintaining the achieved results they will quickly fade away. Typically this period lasts from 3 months to 3 years. On an outpatient basis, patients continue physical therapy exercises in sanatoriums and dispensaries, outpatient physical therapy rooms, medical physical education clinics, as well as at home. Medical monitoring of patients' condition is carried out twice a year.

Features of patient recovery after various types of medical procedures

Abdominal surgery

Like all bedridden patients, patients after abdominal operations should perform breathing exercises to prevent pneumonia, especially in cases where the period of forced immobility is prolonged. Physical therapy after surgery is first carried out in a lying position, and only after the stitches begin to heal does the doctor allow you to perform exercises in a sitting and standing position.

Physiotherapy is also prescribed, in particular, UHF therapy, laser therapy, magnetic therapy, diadynamic therapy and electrophoresis.

After abdominal operations, patients are advised to follow a special gentle diet, especially if the operation was performed on the gastrointestinal tract. Patients should wear supportive underwear and bandages, this will help the muscles quickly restore tone.

Joint surgeries

The early postoperative period during surgical manipulation of the joints includes exercise therapy and exercises that reduce the risk of complications from the respiratory system and cardiovascular system, as well as stimulation of peripheral blood flow in the extremities and improvement of mobility in the operated joint.

After this, strengthening the muscles of the limbs and restoring the normal pattern of movement (and in cases where this is impossible, developing a new one that takes into account changes in condition) comes to the fore. At this stage, in addition to physical education, methods of mechanotherapy, training on simulators, massage, and reflexology are used.

After discharge from the hospital, it is necessary to maintain the result with the help of regular exercises and conduct classes to adapt to normal daily physical activity (ergotherapy).

Femoral neck endoprosthetics

Despite the seriousness of the operation, recovery from femoral neck replacement is usually relatively quick. In the early stages, the patient needs to perform exercises that will strengthen the muscles around the new joint and restore its mobility, and also prevent blood clots from forming. Rehabilitation after hip replacement also includes learning new motor skills - the doctor will show you how to sit down, stand up and bend over correctly, and how to perform normal everyday movements without the risk of injuring your hip. Physical therapy exercises in the pool are of great importance. Water allows you to move freely and eases the load on the operated hip. It is very important not to stop the rehabilitation course prematurely - in the case of hip surgeries this is especially dangerous. Often people, feeling that they can easily move without assistance, quit classes. But weak muscles quickly weaken, and this increases the risk of falling and injury, after which everything will have to start all over again.

Medical rehabilitation is not a new idea. Even in ancient Egypt, healers used some occupational therapy techniques to speed up the recovery of their patients. Doctors of ancient Greece and Rome also used physical education and massage in treatment. The founder of medicine, Hippocrates, wrote the following saying: “A doctor must be experienced in many things and, by the way, in massage.”

Heart surgery

Such operations are a real miracle of modern medicine. But a speedy recovery after such an intervention depends not only on the skill of the surgeon, but also on the patient himself and his responsible attitude towards his health. Yes, heart surgery does not limit mobility as much as surgical manipulation of the joints or spine, but this does not mean that rehabilitation treatment can be neglected. Without it, patients often suffer from depression and their vision deteriorates due to swelling of the eye structures. Statistics show that every third patient who has not completed the rehabilitation course soon finds himself on the operating table again.

The rehabilitation program after heart surgery necessarily includes diet therapy. Patients are prescribed dosed cardio exercises under the supervision of a doctor and physical therapy, exercises in the pool (six months after surgery), balneotherapy and circular showers, massage and hardware physiotherapy. An important part of the rehabilitation program is psychotherapy, both group and individual.

Is it possible to carry out rehabilitation at home? Experts believe not. It is simply impossible to organize all the necessary events at home. Of course, the patient can perform the simplest exercises without the supervision of a doctor, but what about physiotherapeutic procedures, training on exercise machines, therapeutic baths, massage, psychological support and other necessary measures? In addition, at home, both the patient and his family often forget about the need for systematic rehabilitation. Therefore, recovery should take place in a special institution - a sanatorium or rehabilitation center.