Removal of the uterus and appendages postoperative period. Postoperative period: features of the course, possible complications

Surely every person has encountered some kind of illness at least once. While some diseases are fairly mild and end quickly, others may require surgical intervention. This article will introduce you to a medical term called “postoperative monitoring.” You will learn what is special about caring for a patient during this time. It is also worth talking about what the postoperative period is in a general sense.

Postoperative period

This time begins from the moment the patient is removed from the surgical table. In this case, the analgesic effect (anesthesia) may still continue. The postoperative period ends when the patient ceases to feel any discomfort from the manipulation and returns to the usual rhythm of life.

Most of the postoperative period takes place within the walls of the hospital. This is where the patient is monitored (postoperative control). In some cases, the patient may leave the hospital immediately after he comes to his senses. In this case, the person is prescribed appropriate postoperative treatment and given the necessary recommendations.

Depending on the complexity of the surgical intervention, the time can last from several days to six months. In this case, the patient’s age, body weight and other factors play an important role.

How is the postoperative period going?

If the patient is within the walls of a hospital, then orderlies, nurses and doctors look after him. When a person is sent home, recommendations for care are given to the person accompanying him. Postoperative monitoring has several main criteria. Let's look at them in more detail.

Bed rest

A prerequisite for recovery after surgery is complete rest. Depending on how severe the operation was performed, mobility restrictions may be set for several hours or days.

When performing gynecological operations (curettage of the uterine cavity, laparoscopy, etc.), the patient's mobility is limited for several hours. So, the patient can get up as soon as the anesthesia wears off.

If the operation is performed on blood vessels, veins and arteries, then the limitation of mobility depends on the area of ​​damaged skin (postoperative suture).

During operations on vital organs (liver, kidneys, stomach, etc.), the patient is prescribed bed rest for several days.

If surgery is performed on the heart area, then the patient can remain at rest for as long as the doctor says. In some cases, a very long stay in a horizontal position is required. Similar recommendations are given after

Following a special diet

A postoperative diet is prescribed in almost all cases. The patient is not allowed to eat immediately after he regains consciousness. Despite the frequent feeling of hunger? On the first day after the intervention, the patient is only allowed to drink water. All this is explained by the fact that after anesthesia, a feeling of severe nausea and vomiting may occur.

A postoperative diet in the following days is recommended only for those people who have undergone surgery on the digestive organs. Thus, during gynecological operations, it is necessary to wait until the stool is restored before transferring the patient to the general table. If the operation was performed on the area of ​​the stomach, intestines and gallbladder, then the diet can be recommended for life.

Treatment after surgery

Postoperative care involves timely treatment. So, after each surgical intervention, the patient is prescribed an antibacterial course. Even if no difficulties arise, and there is no inflammatory process, then these drugs are taken to prevent postoperative complications from appearing.

In addition to antibiotics, a person may be given medications aimed at correcting the organ being operated on. Thus, in the case of gynecological interventions, venotonics and drugs are prescribed for operations on blood vessels and veins. During surgical treatment of the digestive organs, medications may be prescribed to improve the digestion of food and facilitate its absorption.

Monitoring the patient's condition

Postoperative monitoring also involves monitoring the patient's condition. To do this, tests (blood and urine tests) are regularly prescribed to detect the inflammatory process.

Also, depending on the area being operated on, manual inspection or ultrasound may be required. In more rare cases, an x-ray or magnetic resonance imaging is prescribed.

If postoperative complications are discovered during the examination, the recovery period may be significantly delayed.

Completion of the postoperative period

Postoperative monitoring ends when the patient's sutures are removed. From this moment on, a person’s health depends on his compliance with the recommendations. Despite this, the patient should regularly visit the doctor for examination and monitoring.

Summarizing

Now you know what postoperative care is and what are the features of this period. If you are undergoing planned surgical intervention, then you should find out in advance what recommendations will be given after the procedure and prepare for them. Always follow your doctor’s orders and listen to everything the specialist says. Only in this case the postoperative period will pass as quickly, easily and without complications as possible. I wish you good health and a speedy recovery!

Operation Cataract removal takes no more than 15 minutes, but the postoperative period is an integral part of the treatment.

Full recovery usually takes 6 months, this period may vary depending on the patient’s condition, his age, ability to regenerate, degree of illness, lifestyle and compliance with the postoperative regimen.

The rehabilitation period also depends on the method used to perform the operation.

According to statistics, after laser surgery, recovery is faster and easier than after ultrasound.

Basic rules for rehabilitation after surgery

With the right approach, following all instructions and daily routine, the postoperative period will pass quickly and without complications.

Compliance with the regime

Adequate rest and moderate activity are necessary, this means 8 hours of sleep. In the first days, it is not recommended to go outside (if necessary, you can only go outside wearing a special bandage).

High-quality nutrition is very important; the menu should be varied and rich in fiber, vegetables and fruits. You can eat dairy products, lean meats, and definitely broths.

This will help avoid constipation; it is not advisable for the first 10 days.

If there is a predisposition, then at first it is necessary to carry out prevention, it is permissible to use a little herbal laxative.

Sometimes the attending physician prescribes a diet based on individual characteristics, which must be followed.

It is worth refusing to bend in any direction, if you need to pick up an object from the floor, doctors recommend that you first sit down without bending your torso, then bend over a little.

Do not lift heavy objects or carry heavy objects - this can lead to increased intraocular pressure and sometimes hemorrhage.

During the first 7 days, go outside only wearing a gauze bandage. Do all manipulations on time, namely dressings, instilling drops, regular visits to the doctor, and if there are any signs of complications, attend an unscheduled appointment.

After surgery to remove cataracts, the eye begins to see after 2 hours, but vision loses its sharpness, fogginess and blurriness of objects are possible. That's why Doctors prescribe wearing glasses for the rehabilitation period.

Lens diopters can vary greatly from each other, and experts insist on individual production; it is strictly forbidden to rent glasses or buy ready-made options. This may cause vision impairment.

Carrying out hygiene procedures

The operation, when the cataract is removed, in the postoperative period involves observing the rules of personal hygiene.

This measure will prevent both viral and bacterial infections, which are the cause of complications.

Daily washing should be done without using cosmetics, with warm, running water, with your eyes closed.

You should bathe in the shower; hot baths should be avoided. When washing your hair, tilt your head back as much as possible to prevent shampoo from getting into your eyes.

Using a special bandage

This is a necessary measure after cataract removal. After surgery, the doctor applies a special bandage. It performs a protective function and is removed only the next day.

Then the patient independently washes the eye daily using furatsilin solution. Cover your eye and blot it several times with a sterile cotton swab.

Then apply a protective gauze bandage. Fold a sterile napkin in half and carefully fix it on your head with a bandage; for better fixation, you can additionally use a plaster.

Using eye drops

During the rehabilitation period, the doctor prescribes medications:

Visiting your doctor

It is necessary to come for examination to a specialist the next day after the operation, then after 10 days for a second examination.

But at the first signs of inflammation, complications, severe pain, or sensation of a foreign body, it is worth visiting an ophthalmologist unscheduled.

Also, if you experience the following symptoms, you should immediately consult a doctor:

How to properly apply eye drops during rehabilitation

You should lie on your back, tilt your head back a little. Then pull back the lower eyelid with your index finger without using force and drop 1 drop.

Do not touch the dispenser to your eye, keep the bottle upright. If you need to repeat the procedure, you should wait 1-2 minutes and repeat the manipulation.

Remove excess liquid with a clean, sterile napkin and wipe the skin without touching the eye or pressing on nearby tissue.

What not to do in the postoperative period after cataract surgery

The operation was performed and the cataract was removed; the postoperative period requires some restrictions:

What to do if complications occur

It is important to know! If, however, water or foam from a cosmetic product penetrates into the operated eye, then it is necessary to immediately rinse with a specially prepared furatsilin solution.

If there is slight redness, it usually goes away after applying the drops.

Inflammatory processes - these include inflammation of the conjunctiva, blood vessels of the eye, and iris. You need to see a doctor. A specialist prescribes anti-inflammatory drops, and within a few weeks the eye returns to normal.

High intraocular pressure - the patient experiences pain in the eye sockets, which may develop into a headache. There is pain in the eyes, and a feeling of heaviness when closed.

The doctor prescribes drops; they stabilize the functioning of the circulatory system of the eyeball.

Hemorrhage is reddening of the white as a result of a ruptured vessel.– occurs extremely rarely, is accompanied by pain and possible visual impairment. You should consult a doctor immediately.

Retinal edema - occurs due to mechanical impact, accompanied by unpleasant sensations and a blurred image. Therapy with eye drops is necessary.

Retinal detachment – ​​patients with myopia are at risk, but if you follow all the rules for care after surgery and use drops, this complication can be avoided.

Displacement of the lens - occurs when lifting heavy objects and during active physical activity during rehabilitation. Requires immediate surgical intervention.

What further eye care after cataract removal?

After the rehabilitation period is completed, it is necessary to treat your vision with care and follow the following recommendations:

If you follow all the rules in the postoperative period after cataract surgery, you can avoid complications. This will allow you to recover faster, as well as improve your visual acuity, maintaining your health for a long time.

This video will tell you about cataract surgery and the postoperative period:

This video will tell you about the prohibitions in the postoperative period after cataract removal:

Content

After intervention in the body of a sick patient, a postoperative period is required, which is aimed at eliminating complications and providing competent care. This process is carried out in clinics and hospitals and includes several stages of recovery. At each period, attentiveness and care for the patient on the part of the nurse, and medical supervision are required to exclude complications.

What is the postoperative period

In medical terminology, the postoperative period is the time from the end of the operation until the patient’s complete recovery. It is divided into three stages:

• early period – before discharge from hospital;
• late – after two months after surgery;
• long-term period is the final outcome of the disease.

How long does it last

The end of the postoperative period depends on the severity of the disease and the individual characteristics of the patient’s body, aimed at the recovery process. Recovery time is divided into four phases:

• catabolic – an upward change in the excretion of nitrogenous wastes in the urine, dysproteinemia, hyperglycemia, leukocytosis, weight loss;
• period of reverse development - the influence of hypersecretion of anabolic hormones (insulin, somatotropic);
• anabolic – restoration of electrolyte, protein, carbohydrate, fat metabolism;
• period of increasing healthy body weight.

Goals and objectives

Observation after surgery is aimed at restoring normal activity of the patient. The objectives of the period are:

• prevention of complications;
• recognition of pathologies;
• patient care - administration of analgesics, blockades, provision of vital functions, dressings;
• preventive measures to combat intoxication and infection.

Early postoperative period

The early postoperative period lasts from the second to the seventh day after surgery. During these days, doctors eliminate complications (pneumonia, respiratory and renal failure, jaundice, fever, thromboembolic disorders). This period affects the outcome of the operation, which depends on the state of kidney function. Early postoperative complications are almost always characterized by impaired renal function due to the redistribution of fluid in sectors of the body.

Renal blood flow decreases, which ends on days 2-3, but sometimes the pathologies are too serious - loss of fluid, vomiting, diarrhea, disruption of homeostasis, acute renal failure. Protective therapy, replenishment of blood loss, electrolytes, and stimulation of diuresis help avoid complications. Frequent causes of the development of pathologies in the early period after surgery are shock, collapse, hemolysis, muscle damage, and burns.

Complications

Complications of the early postoperative period in patients are characterized by the following possible manifestations:

• dangerous bleeding – after operations on large vessels;
• cavity bleeding - during intervention in the abdominal or thoracic cavities;
• pallor, shortness of breath, thirst, frequent weak pulse;
• divergence of wounds, damage to internal organs;
• dynamic paralytic ileus;
• persistent vomiting;
• the possibility of peritonitis;
• purulent-septic processes, fistula formation;
• pneumonia, heart failure;
• thromboembolism, thrombophlebitis.

Late postoperative period

After 10 days from the moment of surgery, the late postoperative period begins. It is divided into hospital and home leave. The first period is characterized by an improvement in the patient’s condition and the beginning of movement around the ward. It lasts 10-14 days, after which the patient is discharged from the hospital and sent for home postoperative recovery, a diet, vitamin intake and activity restrictions are prescribed.

Complications

The following late complications after surgery are identified, which occur while the patient is at home or in the hospital:

• postoperative hernias;
• adhesive intestinal obstruction;
• fistulas;
• bronchitis, intestinal paresis;
• repeated need for surgery.

Doctors cite the following factors as the causes of complications in the later stages after surgery:

• long period of stay in bed;
• initial risk factors – age, illness;
• impaired respiratory function due to prolonged anesthesia;
• violation of the rules of asepsis for the operated patient.

Nursing care in the postoperative period

An important role in caring for the patient after surgery is played by nursing care, which continues until the patient is discharged from the department. If it is not enough or is performed poorly, this leads to unfavorable outcomes and prolongation of the recovery period. The nurse should prevent any complications, and if they occur, make efforts to eliminate them.

The duties of a nurse in postoperative patient care include the following responsibilities:

• timely administration of medications;
• patient care;
• participation in feeding;
• hygienic care of skin and oral cavity;
• monitoring for deterioration and providing first aid.

From the moment the patient enters the intensive care ward, the nurse begins to perform her duties:

• ventilate the room;
• eliminate bright light;
• position the bed for a comfortable approach to the patient;
• monitor the patient's bed rest;
• prevent cough and vomiting;
• monitor the position of the patient's head;
• feed.

How is the postoperative period going?

Depending on the patient’s condition after surgery, the following stages of postoperative processes are distinguished:

• strict bed rest period - it is forbidden to get up or even turn around in bed, any manipulation is prohibited;
• bed rest - under the supervision of a nurse or exercise therapy specialist, it is allowed to turn over in bed, sit down, lower your legs;
• ward period - it is allowed to sit on a chair and walk for a short time, but examination, feeding and urination are still carried out in the ward;
• General regime – patient self-care, walking along the corridor, offices, and walks in the hospital area are allowed.

Bed rest

After the risk of complications has passed, the patient is transferred from intensive care to the ward, where he must remain in bed. The goals of bed rest are:

• limitation of physical activity, mobility;
• adaptation of the body to hypoxia syndrome;
• pain reduction;
• restoration of strength.

Bed rest is characterized by the use of functional beds, which can automatically support the patient’s position - on the back, stomach, side, half-lying, half-sitting. The nurse cares for the patient during this period - changes underwear, helps to cope with physiological needs (urination, defecation) if they are difficult, feeds and carries out hygiene procedures.

Following a special diet

The postoperative period is characterized by adherence to a special diet, which depends on the volume and nature of the surgical intervention:

1. After operations on the gastrointestinal tract, enteral nutrition is provided for the first days (through a tube), then broth, jelly, and crackers are given.
2. When operating on the esophagus and stomach, the first food should not be taken through the mouth for two days. Parenteral nutrition is provided - subcutaneous and intravenous administration of glucose and blood substitutes through a catheter, and nutritional enemas are performed. From the second day broths and jelly can be given, on the 4th day crackers are added, on the 6th day mushy food, from the 10th day a common table.
3. In the absence of violations of the integrity of the digestive organs, broths, pureed soups, jelly, and baked apples are prescribed.
4. After operations on the colon, conditions are created so that the patient does not have stool for 4-5 days. Low fiber diet.
5. When operating on the oral cavity, a probe is inserted through the nose to provide liquid food.

You can start feeding patients 6-8 hours after surgery. Recommendations: maintain water-salt and protein metabolism, provide sufficient amounts of vitamins. A balanced postoperative diet for patients consists of 80-100 g of protein, 80-100 g of fat and 400-500 g of carbohydrates daily. Enteral formulas, dietary canned meat and vegetables are used for feeding.

Intensive monitoring and treatment

After the patient is transferred to the recovery room, intensive monitoring begins and, if necessary, treatment of complications is carried out. The latter are eliminated with antibiotics and special medications to maintain the operated organ. The tasks of this stage include:

• assessment of physiological parameters;
• eating as prescribed by the doctor;
• compliance with the motor regime;
• administration of drugs, infusion therapy;
• prevention of pulmonary complications;
• wound care, drainage collection;
• laboratory tests and blood tests.

Features of the postoperative period

Depending on which organs underwent surgical intervention, the features of patient care in the postoperative process depend:

1. Abdominal organs - monitoring the development of bronchopulmonary complications, parenteral nutrition, preventing gastrointestinal paresis.
2. Stomach, duodenum, small intestine - parenteral nutrition for the first two days, including 0.5 liters of liquid on the third day. Aspiration of gastric contents for the first 2 days, probing according to indications, removal of sutures on days 7-8, discharge on days 8-15.
3. Gallbladder - special diet, drainage removal, allowed to sit for 15-20 days.
4. Large intestine - the most gentle diet from the second day after surgery, there are no restrictions on fluid intake, the administration of Vaseline oil orally. Discharge – 12-20 days.
5. Pancreas – preventing the development of acute pancreatitis, monitoring the level of amylase in the blood and urine.
6. The organs of the thoracic cavity are the most severe traumatic operations, threatening blood flow disruption, hypoxia, and massive transfusions. For postoperative recovery, it is necessary to use blood products, active aspiration, and chest massage.
7. Heart – hourly diuresis, anticoagulant therapy, drainage of cavities.
8. Lungs, bronchi, trachea - postoperative prevention of fistulas, antibacterial therapy, local drainage.
9. Genitourinary system – postoperative drainage of urinary organs and tissues, correction of blood volume, acid-base balance, sparing caloric nutrition.
10. Neurosurgical operations – restoration of brain functions and respiratory ability.
11. Orthopedic and traumatological interventions - compensation of blood loss, immobilization of the damaged part of the body, physical therapy is given.
12. Vision – 10-12 hours of bed rest, walking from the next day, regular use of antibiotics after corneal transplant.
13. In children - postoperative pain relief, elimination of blood loss, support of thermoregulation.

Resection of hemorrhoids does not yet make it possible to assume that everything is over. Following the recommendations of a proctologist in the postoperative period after removal of hemorrhoids is an important therapeutic stage, and the prognosis of treatment and the likelihood of developing complications depend on how well the rectum and anus function. To recover from the disease, you need to familiarize yourself with the basic principles of postoperative rehabilitation.

Duration of the postoperative period

The length of recovery time after hemorrhoid surgery depends on a number of factors:

• surgical techniques;
• type of hemorrhoidal lesion (internal, external or combined);
• age;
• existing intestinal diseases;
• functioning of the immune system (chronic diseases slow down postoperative treatment and increase the risk of complications).

How long does post-operative recovery last? On average, rehabilitation after removal of hemorrhoids lasts from 2 weeks to one and a half months, and the further prognosis of the disease depends on how well the patient follows medical recommendations during this time.

Main rules of rehabilitation

The recovery technique in the postoperative period is selected individually for each patient and is aimed at restoring the full functioning of the blood vessels. Treatment after hemorrhoidectomy should be comprehensive and include the following:

• Use of medications. To speed up the healing of postoperative sutures, ointments or suppositories are used topically after surgery with an analgesic, wound-healing, anti-inflammatory or hemostatic effect (medicines are selected taking into account the patient’s problem after resection of hemorrhoids). If the operation is successful, treatment with medications may not be required.
• Diet food. While scars are healing after excision of hemorrhoids, it is necessary to minimize the risk of injury to the mucous membrane of the rectum or anus from intestinal gases and dense feces. During the recovery period, food should be easily absorbed by the body and not linger in the intestines.
• Maintaining hygiene. It is necessary to wash the anus with cool water and baby soap. Failure to maintain hygiene in the postoperative period after removal of hemorrhoids often causes infection of the sutures with pathogenic microflora.
• Adequate physical activity. Despite the fact that approximately 4 days after surgery for hemorrhoids, many patients feel significantly better compared to the preoperative state, scar healing has not yet occurred and it is necessary to minimize physical stress on the pelvic area to prevent possible complications.

In order for recovery after hemorrhoid removal to proceed without complications, you must follow all points of medical recommendations. Failure to comply with the rules of rehabilitation may cause the recurrence of hemorrhoidal cones or the development of other problems in the patient.

Patient problems in the early period of rehabilitation

Removing hemorrhoids surgically does not always immediately relieve the patient of problems; early postoperative complications often arise. Most often, patients experience the following discomfort symptoms:

• Severe pain syndrome. After the anesthesia wears off, patients experience pain in the anus. Sometimes the pain is so unbearable that to alleviate a person’s condition, injections of non-narcotic (Nimesulide, Diclofenac) or narcotic (Promedol, Omnopon) analgesics are prescribed. Typically, severe pain lasts no more than 2-3 days and gradually subsides as postoperative scars heal.
• Urinary retention. Temporary difficulty urinating occurs more often in men after hemorrhoid surgery, when epidural anesthesia was used. The disorder is temporary and treatment is rarely required; usually normal urination is restored on its own within 24 hours after removal of hemorrhoids. In order to alleviate the condition, patients are shown catheterization of the bladder.
• Prolapse of a section of the rectum. Such consequences after removal of hemorrhoids do not occur often in patients and usually appear when the anal sphincter was damaged during the operation or the person has valve weakness. To eliminate the resulting disorder, depending on the severity of the condition, conservative or surgical treatment is used.
• Narrowing of the anus. This happens if the hemorrhoidectomy was done with improper suturing. In patients, the consequences of improper suturing of surgical wounds will be pain during bowel movements and a constant feeling of under-emptying of the intestines.

Surgery to remove hemorrhoids, apart from pain in the operated area, may not cause any negative consequences, but a number of patients experience psychological problems associated with the act of defecation. A person is afraid of stool retention and at the same time experiences fear of going to the toilet. To eliminate the problem, laxatives and, for pain, mild analgesics are prescribed. In severe cases, patients need the help of a psychologist to combat fear.

A psychological problem with bowel movements, if not treated promptly, will eventually lead to constipation and injury to the anus.

Basics of therapeutic nutrition

Full recovery after surgery directly depends on what a person eats. Nutrition during the recovery period must comply with the following rules:

• Balance. Despite the exclusion of a number of foods from the diet, the body must receive the necessary vitamins and nutrients.
• Fractionality. It is recommended to eat in small portions, but often (up to 5-6 times a day).
• Cooking method. To reduce the risk of intestinal disorders, it is not recommended to fry food; it is advisable to prepare dishes by stewing, baking or boiling.
• Method of eating. Each piece should be chewed thoroughly before swallowing and avoid drinking various drinks while eating.

The suggested tips will help reduce the risk of constipation and flatulence, which can cause pain and discomfort to the patient during the rehabilitation period.

In addition to the rules of food intake, you should pay attention to the food set, because the proper functioning of the intestines depends on the type of food eaten.

Healthy food

The postoperative menu should include foods rich in fiber and moisture.

• porridge (except rice and semolina);
• vegetable soups;
• vegetable puree;
• omelettes;
• casseroles made from meat or cottage cheese;
• low-fat fermented milk products;
• fruits and berries without seeds;
• compotes and juices;
• ground or finely chopped meat and lean fish.

Prohibited Products

Rehabilitation after surgery requires minimizing the load on the intestines as much as possible. You need to remove from the menu:

• fresh milk;
• fatty fish and meat broths;
• seasonings;
• sauces;
• mayonnaise;
• vegetables with coarse fiber (onions, radishes, spinach, etc.);
• fatty fish and meat;
• rich fresh baked goods;
• any products with cocoa;
• fruits and berries containing small seeds (raspberries, kiwi);
• strong coffee and tea;
• alcoholic drinks;
• sparkling waters.

After the operation is performed, patients are not recommended to eat food during the first 24 hours, and after that they should eat in compliance with the above rules.

Many patients find it difficult to limit themselves in food and very often doctors hear the question: “After resection of hemorrhoids, how long should you follow a diet?” At least as long as the scars heal after surgery (on average, this happens within a month).

Those who are looking forward to finishing their diet so they can eat delicious food should think about the possible consequences: if you eat too much heavy and spicy food, hemorrhoids may reappear after surgery. Proctologists recommend that patients, even after the end of the rehabilitation stage, adhere to a milder version of the proposed diet and eat harmful foods in small quantities.

Physical activity after surgery

Treatment of hemorrhoids does not end with surgery; after removal of hemorrhoidal cones, to ensure full restoration of the body’s functioning, it is necessary to ensure a gentle load on the perineal area during the rehabilitation period. Depending on how much time has passed since the hemorrhoidectomy, doctors may recommend the following:

• In the first days there is complete rest. Patients must observe strict bed rest, and it is strictly forbidden to strain the abs or make sudden movements. During this period, tissues damaged by surgery actively heal and scars form.
• Physical exercises can only be done for 2-3 weeks. Proctologists recommend doing walking in place or breathing exercises. Physical activity that does not cause overstrain of the perineal muscles improves blood supply to the tissues, and scar healing takes less time.

Sexual contact is allowed only 2-3 weeks after hemorrhoidectomy, while anal sexual contact is strictly prohibited.

Postoperative recovery lasts up to 2 months and during this time the patients are considered disabled.

To reduce the risk of recurrence of hemorrhoids, it is recommended not to sit for long periods of time. For people whose work activity involves sitting at a desk or driving for a long time, doctors advise purchasing a special ring cushion for the seat.

• Wear soft underwear. It is unacceptable to wear panties made of coarse synthetic fabrics. And women are prohibited from wearing thongs.
• Wash the perineum with water and baby soap 2 times a day.
• Use only soft toilet paper (if possible, it is recommended to wash with cool water after each bowel movement).

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Possible postoperative complications

Removal of hemorrhoids can be successful, but due to patients’ violation of rehabilitation rules, complications sometimes arise:

• The appearance of suppuration. The most common problem is non-compliance with hygiene rules. If you do not start treating the resulting ulcers in a timely manner, then in the future this will lead to phlegmon or the formation of a rectal fistula.
• The appearance of bleeding. Such a complication becomes a consequence of injury to the areas of the anus and rectum that have not yet healed with feces or due to severe tension in the muscles of the perineum. Bleeding may be minor or profuse (if large vessels are damaged). For treatment, hemostatic sponges are used and, if necessary, injections of hemostatic agents are given.

In most cases, these phenomena can be avoided by following medical recommendations.

Signs of complications

Deviations in postoperative healing can be suspected based on the following signs:

• Prolonged severe pain. The normal duration of severe pain should not exceed 2-3 days; in most operated patients, the pain becomes moderately tolerable within a day after the operation.
• Fever. On the first day, a slight subfebrile rise in temperature is possible, but if hyperthermia lasts for several days, then this is a sign of an inflammatory process.
• The appearance of purulent discharge from the anus (occurs with feces during bowel movements).
• The appearance of blood stains on linen. A small amount of blood in the stool is acceptable, but if the bleeding is profuse and occurs not only when going to the toilet, but also at rest, then this is a dangerous sign.

The consequences accompanying operated hemorrhoids are always dangerous and require immediate treatment. If you ignore the signs that arise, life-threatening conditions may develop in the future.

The surgeon can perform an operation and remove the hemorrhoids, but further recovery depends not only on the doctor, but also on the patient. If the patient strictly follows medical recommendations regarding nutrition, hygiene and physical activity during rehabilitation, then the prognosis is favorable. During the healing period of postoperative scars, the risk of complications is minimal and there is almost no relapse of the disease.

Postoperative period I Postoperative period

Disorders of the central mechanisms of respiratory regulation, which usually arise as a result of depression of the respiratory center under the influence of anesthetic and narcotic drugs used during surgery, can lead to acute respiratory disorders in the immediate area. The basis of intensive therapy for acute respiratory disorders of central origin is artificial pulmonary ventilation (ALV), the methods and options of which depend on the nature and severity of respiratory disorders.

Disturbances in the peripheral mechanisms of respiratory regulation, more often associated with residual muscle relaxation or recurarization, can lead to rare gas exchange disorders and cardiac arrest. In addition, these disorders are possible in patients with myasthenia gravis, myopathies and other peripheral respiratory disorders. It consists of maintaining gas exchange by mask ventilation or repeated tracheal intubation and transfer to mechanical ventilation until muscle tone is completely restored and adequate spontaneous breathing.

Severe breathing disorders can be caused by pulmonary atelectasis, pneumonia, and pulmonary embolism. When clinical signs of atelectasis appear and the diagnosis is confirmed by X-ray, it is necessary to eliminate first of all the cause of atelectasis. With compression atelectasis, this is achieved by draining the pleural cavity to create a vacuum. For obstructive atelectasis, therapeutic bronchoscopy is performed with sanitation of the tracheobronchial tree. If necessary, the patient is transferred to mechanical ventilation. The complex of therapeutic measures includes the use of aerosol forms of bronchodilators, percussion and vibration of the chest, postural.

One of the serious problems in intensive care of patients with respiratory failure is the need for mechanical ventilation. The guidelines for solving this problem are the respiratory rate of more than 35 per 1 min, Stange test less than 15 With, pO 2 below 60 mm rt. st. despite inhalation of a 50% oxygen mixture, hemoglobin oxygen less than 70%, pCO 2 below 30 mm rt. st. . vital capacity of the lungs is less than 40-50%. The determining criterion for the use of mechanical ventilation in the treatment of respiratory failure is the increase in respiratory failure and the insufficient effectiveness of the therapy.

In early P. p. . acute hemodynamic disturbances can be caused by volemic, vascular or cardiac failure. The causes of postoperative hypovolemia are varied, but the main ones are those not replenished during surgery or ongoing internal or external ones. The most accurate assessment of the state of hemodynamics is given by comparing central venous pressure (CVP) with pulse and prevention of postoperative hypovolemia is the full compensation of blood loss and circulating blood volume (CBV), adequate pain relief during surgery, careful surgical intervention, ensuring adequate gas exchange and correction of disorders metabolism both during surgery and in early P. p. The leading place in intensive therapy for hypovolemia is occupied by therapy aimed at replenishing the volume of circulating fluid.

Vascular insufficiency develops as a result of toxic, neurogenic, toxic-septic or allergic shock. In modern conditions, cases of anaphylactic and septic shock have become more frequent in P. for anaphylactic shock (Anaphylactic shock) consists of intubation and mechanical ventilation, the use of adrenaline, glucocorticoids, calcium supplements, and antihistamines. Heart failure is a consequence of cardiac (angina, surgery) and extracardiac (toxicoseptic myocardial) causes. Its therapy is aimed at eliminating pathogenetic factors and includes the use of cardiotonic agents, coronary lytics, anticoagulants, electrical pulse cardiac stimulation, and assisted cardiopulmonary bypass. In case of cardiac arrest, cardiopulmonary resuscitation is used.

The course of P. p. to a certain extent depends on the nature of the surgical intervention, existing intraoperative complications, the presence of concomitant diseases, and the age of the patient. With a favorable course, P. p. in the first 2-3 days can be increased to 38°, and the difference between the evening and morning temperatures does not exceed 0.5-0.6°. The pain gradually subsides by the 3rd day. The pulse rate in the first 2-3 days remains within 80-90 beats per 1 min, CVP and blood pressure are at the level of preoperative values; the next day after surgery, only a slight increase in sinus rhythm is noted. After operations under endotracheal anesthesia, the next day the patient coughs up a small amount of mucous sputum, breathing remains vesicular, and single dry sounds can be heard, disappearing after coughing up the sputum. the skin and visible mucous membranes do not undergo any changes compared to their color before the operation. remains moist and may be covered with a whitish coating. corresponds to 40-50 ml/h, there are no pathological changes in the urine. After operations on the abdominal organs, the abdominal cavity remains symmetrical; bowel sounds are sluggish on days 1-3. Moderate is allowed on the 3-4th day of P. p. after stimulation, cleansing. The first postoperative revision is carried out the next day after the operation. In this case, the edges of the wound are not hyperemic, not swollen, the sutures do not cut into the skin, and the wound remains moderate during palpation. and hematocrit (if there was no bleeding during surgery) remain at the original values. On the 1st-3rd day, moderate leukocytosis with a slight shift of the formula to the left, a relative increase in ESR may be observed. In the first 1-3 days, slight hyperglycemia is observed, but sugar in the urine is not detected. A slight decrease in the level of albumin-globulin ratio is possible.

In elderly and senile people, early P. is characterized by the absence of an increase in body temperature; more pronounced and fluctuations in blood pressure, moderate (up to 20 V 1 min) and a large amount of sputum in the first postoperative days, sluggish tract. the wound heals more slowly, eventration and other complications often occur. Possible.

Due to the tendency to reduce the time a patient spends in hospital, an outpatient surgeon has to observe and treat some groups of patients already from the 3-6th day after surgery. For a general surgeon in an outpatient setting, the most important are the main complications of P. p., which can occur after operations on the abdominal and thoracic organs. There are many risk factors for the development of postoperative complications: concomitant diseases, long duration of surgery, etc. During the outpatient examination of the patient and in the preoperative period in the hospital, these factors must be taken into account and appropriate corrective therapy must be carried out.

With all the variety of postoperative complications, the following signs can be identified that should alert the doctor in assessing the course of P. p. Increased body temperature from the 3rd-4th or 6-7th day, as well as high temperature (up to 39° and above ) from the first day after the operation indicate an unfavorable course of P. p. hectic from the 7-12th day indicates a severe purulent complication. A sign of trouble is pain in the area of ​​the operation, which does not subside by the 3rd day, but begins to increase. Severe pain from the first day of P. p. should also alert the doctor. The reasons for the intensification or resumption of pain in the surgical area are varied: from superficial suppuration to intra-abdominal catastrophe.

Severe tachycardia from the first hours of P. p. or its sudden appearance on the 3-8th day indicates a developed complication. A sudden drop in blood pressure and at the same time an increase or decrease in central venous pressure are signs of a severe postoperative complication. In many complications, the ECG shows characteristic changes: signs of overload of the left or right ventricle, various arrhythmias. The causes of hemodynamic disturbances are varied: heart disease, bleeding, etc.

The appearance of shortness of breath is always alarming, especially on the 3-6th day of P. p. The causes of shortness of breath in P. p. can be pneumonia, septic shock, pleural empyema, pulmonary edema, etc. The doctor should be alerted by sudden unmotivated shortness of breath, characteristic of thromboembolism pulmonary arteries.

Cyanosis, pallor, marbled skin, purple, blue spots are signs of postoperative complications. The appearance of yellowness of the skin often indicates severe purulent complications and developing liver failure. Oligoanuria indicates a severe postoperative situation - renal failure.

A decrease in hemoglobin and hematocrit is a consequence of unreplenished surgical blood loss or postoperative bleeding. A slow decrease in hemoglobin and the number of red blood cells indicates inhibition of erythropoiesis of toxic origin. , lymphopenia or the reappearance of leukocytosis after normalization of the blood count is characteristic of complications of an inflammatory nature. A number of biochemical blood parameters may indicate surgical complications. Thus, an increase in blood and urine levels is observed with postoperative pancreatitis (but also possible with mumps, as well as high intestinal obstruction); transaminases - during exacerbation of hepatitis, myocardial infarction, liver; bilirubin in the blood - with hepatitis, obstructive jaundice, pylephlebitis; urea and creatinine in the blood - with the development of acute renal failure.

Main complications of the postoperative period. Suppuration of a surgical wound is most often caused by aerobic flora, but often the causative agent is anaerobic non-clostridial. The complication usually appears on the 5-8th day of P. p., it can occur after discharge from the hospital, but rapid development of suppuration is also possible already on the 2-3rd day. When the surgical wound suppurates, the body temperature, as a rule, rises again and is usually of a similar nature. Moderate leukocytosis is noted, with anaerobic non-clostridial flora - pronounced lymphopenia, toxic granularity of neutrophils. Diuresis, as a rule, is not impaired.

Local signs of wound suppuration are swelling in the area of ​​the sutures, skin, and severe pain on palpation. However, if suppuration is localized under the aponeurosis and has not spread to the subcutaneous tissue, these signs, with the exception of pain on palpation, may not exist. In elderly and senile patients, general and local signs of suppuration are often erased, and the prevalence of the process at the same time can be large.

Treatment consists of spreading the edges of the wound, sanitation and drainage, and dressings with antiseptics. When granulations appear, ointment is prescribed and secondary sutures are applied. After careful excision of purulent-necrotic tissue, suturing with drainage and further flow-drip washing of the wound with various antiseptics with constant active aspiration are possible. For extensive wounds, surgical necrectomy (complete or partial) is supplemented with laser, X-ray or ultrasound treatment of the wound surface, followed by the use of aseptic dressings and the application of secondary sutures.

If suppuration of a postoperative wound is detected when a patient visits a surgeon in a clinic, then with superficial suppuration in the subcutaneous tissue, treatment on an outpatient basis is possible. If suppuration in deep-lying tissues is suspected, hospitalization in the purulent department is necessary, because in these cases, more complex surgery is required.

Currently, the danger of clostridial and non-clostridial infection (see Anaerobic infection), which may show signs of shock, high body temperature, hemolysis, and increasing subcutaneous crepitus, is becoming increasingly important in P. At the slightest suspicion of an anaerobic infection, urgent hospitalization is indicated. In the hospital, the wound is immediately opened wide, non-viable tissue is excised, intensive antibiotic therapy is started (penicillin - up to 40,000,000 or more per day intravenously, metronidazole - 1 G per day, clindamycin intramuscularly 300-600 mg every 6-8 h), carry out serotherapy, carry out hyperbaric oxygenation (Hyperbaric oxygenation).

Due to inadequate hemostasis during the operation or other reasons, hematomas may occur located under the skin, under the aponeurosis or intermuscularly. Deep hematomas in the retroperitoneal tissue, pelvic and other areas are also possible. In this case, the patient is bothered by pain in the area of ​​the operation, upon examination of which swelling is noted, and after 2-3 days - in the skin around the wound. Small hematomas may not be clinically apparent. When a hematoma appears, the wound is opened, its contents are evacuated, hemostasis is carried out, the wound cavity is treated with antiseptic solutions and the wound is sutured using any measures to prevent possible subsequent suppuration.

Therapy of psychosis consists of treating the underlying disease in combination with the use of antipsychotics (see Antipsychotics), antidepressants (Antidepressants) and tranquilizers (Tranquilizers). almost always favorable, but worsens in cases where states of stupefaction are replaced by intermediate syndromes.

Thrombophlebitis most often occurs in the system of superficial veins that were used during or after surgery for infusion therapy. As a rule, superficial veins of the upper extremities are not dangerous and are stopped after local treatment, including immobilization of the limb, the use of compresses, heparin ointment, etc. Superficial thrombophlebitis of the lower extremities can cause deep phlebitis with the threat of thromboembolism of the pulmonary arteries. Therefore, in the preoperative period, it is necessary to take into account coagulogram data and factors such as a history of thrombophlebitis, complicated, lipid metabolism disorders, vascular diseases, and lower extremities. In these cases, the limbs are bandaged and measures are taken to combat anemia, hypoproteinemia and hypovolemia, and normalize arterial and venous circulation. In order to prevent thrombus formation in the P. p., along with adequate restoration of homeostasis in patients with risk factors, it is advisable to prescribe direct and indirect action.

One of the possible complications of P. p. is pulmonary arteries. Pulmonary artery thromboembolism (pulmonary embolism) is more common, fatty and air embolism is less common. The volume of intensive care for pulmonary embolism depends on the nature of the complication. In the fulminant form, resuscitation measures are necessary (trachea, mechanical ventilation, closed). Under appropriate conditions, it is possible to perform emergency thromboembolectomy with mandatory massage of both lungs or catheterization embolectomy followed by anticoagulant therapy against the background of mechanical ventilation. For partial embolism of the branches of the pulmonary arteries with a gradually developing clinical picture, fibrinolytic and anticoagulant therapy is indicated.

The clinical picture of postoperative peritonitis is diverse: abdominal pain, tachycardia, gastrointestinal tract problems that cannot be controlled by conservative measures, changes in the blood count. The outcome of treatment depends entirely on timely diagnosis. Relaparotomy is performed, the source of peritonitis is eliminated, the abdominal cavity is sanitized, adequately drained, and nasointestinal intubation is performed.

Eventration, as a rule, is a consequence of other complications - paresis of the gastrointestinal tract, peritonitis, etc.

Postoperative pneumonia can occur after severe operations on the abdominal organs, especially in elderly and senile people. In order to prevent it, inhalations, cupping, breathing exercises, etc. are prescribed. Postoperative pleura can develop not only after operations on the lungs and mediastinum, but also after operations on the abdominal organs. The chest plays a leading role in diagnosis.

Outpatient management of patients after neurosurgical operations. Patients after neurosurgical operations usually require long-term outpatient observation and treatment for the purpose of psychological, social and occupational rehabilitation. After surgery for traumatic brain injury (traumatic brain injury), complete or partial impairment of cerebral functions is possible. However, in some patients with traumatic arachnoiditis and arachnoencephalitis, hydrocephalus, epilepsy, various psychoorganic and vegetative syndromes, the development of cicatricial adhesions and atrophic processes, disorders of hemo- and liquor dynamics, inflammatory reactions, and immune failure is observed.

After removal of intracranial hematomas, hygromas, areas of brain crush, etc. anticonvulsant therapy is carried out under the control of electroencephalography (Electroencephalography). In order to prevent epileptic seizures, which develop after severe traumatic brain injury in approximately 1/3 of patients, drugs containing phenobarbital (pagluferal = 1, 2, 3, gluferal, etc.) are prescribed for 1-2 years. For epileptic seizures that appear as a result of traumatic brain injury, therapy is selected individually, taking into account the nature and frequency of epileptic paroxysms, their dynamics, age and general condition of the patient. Various combinations of barbiturates, tranquilizers, nootropics, anticonvulsants and sedatives are used.

To compensate for impaired brain functions and accelerate recovery, vasoactive (Cavinton, Sermion, Stugeron, Teonicol, etc.) and nootropic (piracetam, encephabol, aminalon, etc.) drugs are used in alternating two-month courses (at intervals of 1-2 months) for 2- 3 years. It is advisable to supplement this basic therapy with agents that affect tissue metabolism: amino acids (cerebrolysin, glutamic acid, etc.), biogenic stimulants (aloe, etc.), enzymes (lidase, lecozyme, etc.).

According to indications, various cerebral syndromes are treated on an outpatient basis - intracranial hypertension (intracranial hypertension), intracranial hypotension (see Intracranial pressure), cephalgic, vestibular (see Vestibular symptom complex), asthenic (see Asthenic syndrome), hypothalamic (see Hypothalamic (Hypothalamic syndromes)), etc., as well as focal ones - pyramidal (see Paralysis), cerebellar, subcortical, etc. In case of mental disorders, observation by a psychiatrist is mandatory.

After surgical treatment of a pituitary adenoma (see Pituitary adenoma), the patient should be monitored along with a neurosurgeon, neurologist and ophthalmologist, since after surgery it often develops (hypothyroidism, insipidus, etc.), requiring hormone replacement therapy.

After transnasosphenoidal or transcranial removal of a prolactotropic pituitary adenoma and an increase in the concentration of prolactin in men, sexual activity decreases, hypogonadism develops, and in women, infertility and lactorrhea. 3-5 months after treatment with Parlodel, patients may recover fully and experience symptoms (during which Parlodel is not used).

When panhypopituitarism develops in P., replacement therapy is carried out continuously for many years, because stopping it can lead to a sharp deterioration in the condition of patients and even death. For hypocortisolism, ACTH is prescribed; for hypothyroidism, it is used. For diabetes insipidus, the use of adiurecrine is mandatory. Replacement therapy for hypogonadism is not always used; in this case, consultation with a neurosurgeon is necessary.

After discharge from the hospital, patients operated on for benign extracerebral tumors (meningiomas, neuromas) are prescribed therapy that helps accelerate the normalization of brain functions (vasoactive, metabolic, vitamin preparations, exercise therapy). In order to prevent possible epileptic seizures, small doses of anticonvulsants are replaced for a long time (usually). To resolve the intracranial hypertension syndrome that often remains after surgery (especially with severe congestive optic nerves), dehydrating drugs (furosemide, diacarb, etc.) are used, recommending their use 2-3 times a week for several months. With the involvement of speech therapists, psychiatrists and other specialists, targeted treatment is carried out to eliminate deficits and correct certain brain functions (speech, vision, hearing, etc.).

For intracerebral tumors, taking into account the degree of their malignancy and the extent of surgical intervention, outpatient treatment according to individual indications includes courses of radiation therapy, hormonal, immune and other drugs in various combinations.

In the outpatient management of patients who have undergone transcranial and endonasal operations for arterial, arteriovenous aneurysms and other vascular malformations of the brain, special attention is paid to the prevention and treatment of ischemic brain lesions. Prescribed drugs that normalize cerebral vessels (aminophylline, no-spa, papaverine, etc.), microcirculation (trental, complamin, sermion, cavinton), brain (piracetam, encephabol, etc.). Similar therapy is indicated when applying extra-intracranial anastomoses. In cases of severe epileptic readiness, according to clinical data and electroencephalography results, preventive anticonvulsant therapy is administered.

Patients who have undergone stereotactic surgery for parkinsonism are often additionally prescribed long-term neurotransmitter therapy (levodopa, nacom, madopar, etc.), as well as anticholinergic drugs (cyclodol and its analogues, tropacin, etc.).

After operations on the spinal cord, long-term, often multi-year treatment is carried out, taking into account the nature, level and severity of the lesion, the radicality of the surgical intervention and the leading clinical syndromes. Prescribed to improve blood circulation, metabolism and trophism of the spinal cord. In case of gross destruction of the spinal cord substance and persistent swelling, proteolysis inhibitors (contrical, gordox, etc.) and dehydrating agents are used (). Pay attention to the prevention and treatment of trophic disorders, especially bedsores (bedsores). Given the high incidence of chronic sepsis in severe spinal cord injuries, on an outpatient basis they may require a course of antibacterial and antiseptic therapy.

Many patients who have undergone spinal cord surgery require correction of dysfunction of the pelvic organs. Bladder catheterization or permanent catheterization, as well as tidal systems are often used for a long time. It is necessary to strictly observe measures to prevent outbreaks of urinary infection (thorough toileting of the genital organs, washing the urinary tract with a solution of furatsilin, etc.). With the development of urethritis, cystitis, pyelitis, pyelonephritis, antibiotics and antiseptics (nitrofuran and naphthyridine derivatives) are prescribed.

For spastic para- and tetraparesis and plegia, antispastic drugs (baclofen, mydocalm, etc.) are used; for flaccid paresis and paralysis, anticholinesterase drugs are used, as well as exercise therapy and massage. After operations for spinal cord injuries, general, segmental and local physiotherapy and balneotherapy are widely used. Transcutaneous electrical stimulation (including the use of implanted electrodes), which helps accelerate reparative processes and restore spinal cord conductivity, is successfully used.

After operations on the spinal and cranial nerves and plexuses (stitching, etc.) on an outpatient basis, many months or many years of rehabilitation treatment are carried out, preferably under thermal imaging control. In various combinations, drugs are used that improve (prozerin, galantamine, oxazil, dibazol, etc.) and trophism of damaged peripheral nerves (groups B, E, aloe, FiBS, vitreous, anabolic agents, etc.). For severe scar processes, lidase, etc. are used. Various options for electrical stimulation, physical and balneotherapy, exercise therapy, massage, as well as early occupational rehabilitation are widely used.

Outpatient management of patients after eye surgery should ensure continuity of treatment in accordance with the surgeon's recommendations. The patient visits an ophthalmologist for the first time in the first week after discharge from the hospital. The therapeutic tactics for patients who have undergone surgery on the eye appendages, after removing the sutures from the skin of the eyelids and conjunctiva, is to monitor the surgical wound. After abdominal operations on the eyeball, the patient is actively observed, i.e. schedules follow-up examinations and monitors the correct implementation of treatment procedures.

After antiglaucomatous operations with a fistulosing effect and a pronounced filtration cushion in early P. p., in an outpatient setting, Shallow Anterior Chamber Syndrome may develop with hypotony due to cilichoroidal detachment, diagnosed with ophthalmic lighting or ultrasound echography, if there are significant changes in the optical media of the eye or a very narrow one that cannot be dilated. In this case, cilichoroidal detachment is accompanied by sluggish iridocyclitis, which can lead to the formation of posterior synechiae, blockade of the internal operating fistula by the root of the iris or processes of the ciliary body with a secondary increase in intraocular pressure. may lead to cataract progression or swelling. In this regard, treatment tactics in an outpatient setting should be aimed at reducing subconjunctival filtration by applying a pressure bandage to the operated patient with placing a thick cotton swab on the upper eyelid and treating Iridocyclitis a. Shallow anterior chamber syndrome can develop after intracapsular cataract extraction, accompanied by an increase in intraocular pressure as a result of difficulty transferring moisture from the posterior chamber to the anterior chamber. The tactics of an outpatient ophthalmologist should be aimed, on the one hand, at reducing the production of intraocular fluid (diacarb, 50% glycerol solution), on the other hand, at eliminating the iridovitreal block by prescribing mydriatics or laser peripheral iridectomy. The lack of a positive effect in the treatment of small anterior chamber syndrome with hypotension and hypertension is an indication for hospitalization.

The management tactics for patients with aphakia after extracapsular cataract extraction and patients with intracapsular pseudophakia are identical (unlike pupillary pseudophakia). When indicated (), it is possible to achieve maximum mydriasis without the risk of dislocation and dislocation of the artificial lens from the capsular pockets. After cataract extraction, it is advisable not to remove supramidal sutures for 3 months. During this time, a smooth operating surface is formed, tissue swelling disappears, decreases or completely disappears. The continuous one is not removed; it resolves over several years. Interrupted sutures, if their ends are not tucked, are removed after 3 months. The indication for suture removal is the presence of astigmatism 2.5-3.0 diopter and more. After the stitches are removed, the patient is prescribed 20% sodium sulfacyl solution instilled into the eye 3 times a day or other medications depending on tolerance for 2-3 days. A continuous suture after penetrating keratoplasty is not removed from 3 months to 1 year. After penetrating keratoplasty, the long-term treatment prescribed by the surgeon is monitored by an outpatient ophthalmologist.

Among the complications in long-term P., a graft or infectious process may develop, most often a herpes viral infection, which is accompanied by graft edema, iridocyclitis, and neovascularization.

Examinations of patients after operations for retinal detachment are carried out on an outpatient basis after 2 weeks, 3 months, 6 months, 1 year and when complaints of photopsia or visual impairment appear. If retinal detachment recurs, the patient is referred to. The same tactics of patient management are followed after vitreectomy for hemophthalmos. Patients who have undergone surgery for retinal detachment and vitreectomy should be warned about following a special regime that excludes low head tilts and heavy lifting; Colds accompanied by coughing and acute shortness of breath, for example, should be avoided.

After operations on the eyeball, all patients must follow a diet that excludes spicy, fried, salty foods and alcoholic beverages.

Outpatient management of patients after abdominal surgery. After operations on the abdominal organs, P. p. may be complicated by the formation of fistulas of the gastrointestinal tract. for patients with artificially formed or naturally occurring fistulas is an integral part of their treatment. Fistulas of the stomach and esophagus are characterized by the release of food masses, saliva and gastric juice; for fistulas of the small intestine - liquid or pasty intestinal chyme, depending on the level of location of the fistula (high or low small intestinal). Discharge from colonic fistulas - . From rectal fistulas, mucopurulent is released, from fistulas of the gallbladder or bile ducts - bile, from pancreatic fistulas - light transparent pancreatic. The amount of discharge from fistulas varies depending on the nature of food, time of day and other reasons, reaching 1.5 l and more. With long-existing external fistulas, their discharge macerates the skin.

Observation of patients with gastrointestinal tract fistulas includes assessment of their general condition (adequacy of behavior, etc.). It is necessary to monitor the color of the skin, the appearance of hemorrhages on it and the mucous membranes (in case of liver failure), determine the size of the abdomen (in case of intestinal obstruction), liver, spleen, and the protective reaction of the muscles of the anterior abdominal wall (in case of peritonitis). At each dressing, the skin around the fistula is cleaned with a soft gauze cloth, washed with warm water and soap, rinsed thoroughly and gently blotted dry with a soft towel. Then it is treated with sterile Vaseline, Lassar paste or syntomycin emulsion.

To isolate the skin in the fistula area, elastic adhesive cellulose-based films, soft pads, patches and activated carbon filters are used. These devices prevent skin and uncontrolled release of gases from the fistula. An important condition for care is the discharge from the fistula in order to avoid contact of the discharge with the skin, underwear and bed linen. For this purpose, a number of devices are used to drain the fistula with discharge of discharge from it (bile, pancreatic juice, urine into a bottle, feces into a colostomy bag). From artificial external biliary fistulas, more than 0.5 l bile, which is filtered through several layers of gauze, diluted with any liquid and given to the patient during meals. Otherwise, severe disturbances of homeostasis are possible. Drains inserted into the bile ducts must be washed daily (with saline or furatsilin) ​​so that they are not encrusted with bile salts. After 3-6 months, these drains must be replaced with x-ray monitoring of their location in the ducts.

When caring for artificial intestinal fistulas (ileo- and colostomies) formed for therapeutic purposes, self-adhesive colostomy bags or colostomy bags attached to a special belt are used. The selection of colostomy bags is made individually, taking into account a number of factors (location of the ileo- or colostomy, its diameter, the condition of the surrounding tissues).

Enteral (tube) administration is important in order to satisfy the patient’s body’s needs for plastic and energy substances. It is considered as one of the types of additional artificial nutrition (along with parenteral), which is used in combination with other types of therapeutic nutrition (see Tube nutrition, Parenteral nutrition).

Due to the exclusion of some parts of the digestive tract from the digestive processes, it is necessary to create a balanced diet, which assumes an average consumption of 80-100 for an adult G squirrel, 80-100 G fat, 400-500 G carbohydrates and the appropriate amount of vitamins, macro- and microelements. Specially developed enteral mixtures (enpits), canned meat and vegetable diets are used.

Enteral nutrition is provided through a nasogastric tube, or a tube inserted through a gastrostomy or jejunostomy. For these purposes, use soft plastic, rubber or silicone tubes with an outer diameter of up to 3-5 mm. The probes have an olive at the end, which facilitates their passage and installation in the initial part of the jejunum. Enteral nutrition can also be provided through a tube that is temporarily inserted into the lumen of an organ (stomach, small intestine) and removed after feeding. Tube feeding can be carried out using the fractional method or drip. The intensity of intake of food mixtures should be determined taking into account the patient’s condition and stool frequency. When performing enteral nutrition through a fistula, in order to avoid regurgitation of the food mass, the probe is inserted into the intestinal lumen at least 40-50 cm using an obturator.

Outpatient management of patients after orthopedic and traumatological operations should be carried out taking into account the postoperative management of patients in the hospital and depends on the nature of the disease or musculoskeletal system for which it was undertaken, on the method and characteristics of the operation performed on a particular patient. The success of outpatient management of patients depends entirely on the continuity of the treatment process begun in a hospital setting.

After orthopedic and traumatological operations, patients can be discharged from the hospital without external immobilization, in various types of plaster casts (see Plaster technique), distraction-compression devices can be applied to the limbs (Distraction-compression devices), patients can use various orthopedic products after surgery (tire-sleeve devices, insoles, arch supports, etc.). In many cases, after operations for diseases and injuries of the lower extremities or pelvis, patients use crutches.

On an outpatient basis, the attending physician should continue to monitor the condition of the postoperative scar so as not to miss superficial or deep suppuration. It may be caused by the formation of late hematomas due to unstable fixation of fragments with metal structures (see Osteosynthesis), loosening of parts of the endoprosthesis when it is not firmly fixed in it (see Endoprosthetics). The causes of late suppuration in the area of ​​the postoperative scar can also be rejection of the allograft due to immunological incompatibility (see Bone grafting), endogenous with damage to the surgical area by hematogenous or lymphogenous route, ligature fistulas. Late suppuration may be accompanied by arterial or venous bleeding caused by purulent melting (arrosion) of the blood vessel, as well as pressure ulcers of the vessel wall under the pressure of a part of a metal structure protruding from the bone during immersion osteosynthesis or a knitting needle of a compression-distraction apparatus. With late suppuration and bleeding, patients require emergency hospitalization.

On an outpatient basis, rehabilitation treatment started in the hospital continues, which consists of therapeutic physical education for joints free from immobilization (see Therapeutic physical education), gypsum and ideomotor gymnastics. The latter consists of contraction and relaxation of the muscles of the limb, immobilized with a plaster cast, as well as imaginary movements in joints fixed by external immobilization (extension) in order to prevent muscle atrophy, improve blood circulation and bone tissue regeneration processes in the area of ​​surgery. Physiotherapeutic treatment continues, aimed at stimulating muscles, improving microcirculation in the surgical area, preventing neurodystrophic syndromes, stimulating the formation of callus, and preventing stiffness in the joints. The complex of rehabilitative treatment in an outpatient setting also includes activities aimed at restoring movements in the limbs necessary for servicing oneself in everyday life (climbing stairs, using public transport), as well as general and professional ability to work. in P., p. is not usually used, with the exception of hydrokinesitherapy, which is especially effective in restoring movements after operations on the joints.

After spinal surgery (without damage to the spinal cord), patients often use semi-rigid or rigid removable corsets. Therefore, in an outpatient setting, it is necessary to monitor the correct use of them and the integrity of the corsets. During sleep and rest, patients should use a hard bed. On an outpatient basis, physical therapy classes aimed at strengthening the back muscles, manual and underwater massage, continue. Patients must strictly adhere to the orthopedic regimen prescribed in the hospital, which consists of unloading the spine.

After surgery on the bones of the limbs and pelvis, the doctor on an outpatient basis systematically monitors the condition of the patients and the timeliness of removing the plaster cast, if an external one was used after the operation, carries out the areas of surgery after removing the plaster, and promptly prescribes the development of joints freed from immobilization. It is also necessary to monitor the condition of metal structures during immersion osteosynthesis, especially with intramedullary or transosseous insertion of a pin or screw, in order to timely detect possible migration, which is detected by X-ray examination. When metal structures migrate with the threat of skin perforation, patients require hospitalization.

If a device for external transosseous osteosynthesis is applied, the task of the outpatient doctor is to monitor the condition of the skin in the area where the pins are inserted, regularly and in a timely manner, and to monitor the stable fastening of the device structures. If necessary, additional fastening is performed, individual units of the device are tightened, and if the inflammatory process begins in the area of ​​the spokes, soft tissues are injected with antibiotic solutions. With deep suppuration of soft tissues, patients need to be sent to a hospital to remove the pin in the area of ​​suppuration and insert a new pin into the unaffected area, and, if necessary, reinstall the device. When the bone fragments are completely consolidated after a fracture or orthopedic surgery, the device is removed on an outpatient basis.

After orthopedic and traumatological operations on joints, physical therapy, hydrokinesitherapy, and physiotherapeutic treatment aimed at restoring mobility are carried out on an outpatient basis. When using transarticular osteosynthesis to fix fragments in cases of intra-articular fractures, the fixing pin (or pins), the ends of which are usually located above the skin, are removed. This manipulation is carried out within a time frame determined by the nature of the damage to the joint. After operations on the knee joint, synovitis is often observed (see Synovial bursae), and therefore it may be necessary to jointly evacuate the synovial fluid and administer medications according to indications, incl. corticosteroids. When postoperative joint contractures develop, along with local treatment, general therapy is prescribed aimed at preventing scarring, para-articular ossification, normalizing the intra-articular environment, regenerating hyaline cartilage (injections of the vitreous, aloe, FiBS, lidase, rumalon, ingestion of non-steroidal anti-inflammatory drugs - indomethacin, brufen, voltaren, etc.). After removal of plaster immobilization, persistent swelling of the operated limb is often observed as a consequence of post-traumatic or postoperative lymphovenous insufficiency. In order to eliminate edema, they recommend manual massage or using pneumatic massagers of various designs, compression of the limb with an elastic bandage or stocking, and physiotherapeutic treatment aimed at improving venous outflow and lymph circulation.

Outpatient management of patients after urological operations is determined by the functional characteristics of the organs of the genitourinary system, the nature of the disease and the type of surgery undergone. for many urological diseases it is an integral part of complex treatment aimed at preventing relapse of the disease and rehabilitation. At the same time, continuity of inpatient and outpatient treatment is important.

To prevent exacerbations of the inflammatory process in the genitourinary system (pyelonephritis, cystitis, prostatitis, epididymo-orchitis, urethritis), continuous sequential use of antibacterial and anti-inflammatory drugs is indicated in accordance with the sensitivity of the microflora to them. The effectiveness of treatment is monitored by regular testing of blood, urine, prostate secretions, and ejaculate culture. If the infection is resistant to antibacterial drugs, multivitamins and nonspecific immunostimulants are used to increase the body's reactivity.

In case of urolithiasis caused by impaired salt metabolism or a chronic inflammatory process, after removal of stones and restoration of urine passage, correction of metabolic disorders is necessary.

After reconstructive operations on the urinary tract (plasty of the ureteropelvic segment, ureter, bladder and urethra), the main task of the immediate and long-term postoperative period is to create favorable conditions for the formation of anastomosis. For this purpose, in addition to antibacterial and anti-inflammatory drugs, agents that promote softening and resorption of scar tissue (lidase) and physiotherapy are used. The appearance of clinical signs of impaired urine outflow after reconstructive surgery may indicate the development of a stricture in the anastomotic area. For its timely detection, regular follow-up examinations, including X-ray radiological and ultrasound methods, are necessary. With a slight degree of narrowing of the urethra, the urethra can be performed and the above set of therapeutic measures can be prescribed. If a patient has chronic renal failure (renal failure) in late renal failure, it is necessary to monitor its course and treatment results through regular examination of biochemical blood parameters, drug correction of hyperazotemia and water and electrolyte disturbances.

After palliative surgery and ensuring the outflow of urine through drainages (nephrostomy, pyelostomy, ureterostomy, cystostomy, urethral catheter), it is necessary to carefully monitor their function. Regular change of drains and washing of the drained organ with antiseptic solutions are important factors in the prevention of inflammatory complications in the genitourinary system.

Outpatient management of patients after gynecological and obstetric operations is determined by the nature of the gynecological pathology, the volume of the operation performed, the characteristics of the course of P. p. and its complications, and concomitant extragenital diseases. A set of rehabilitation measures is carried out, the duration of which depends on the speed of restoration of functions (menstrual, reproductive), complete stabilization of the general condition and gynecological status. Along with general restorative treatment (etc.), physiotherapy is carried out, which takes into account the nature of the gynecological disease. After surgery for tubal pregnancy, medicinal hydrotubation is performed (penicillin 300,000 - 500,000 units, hydrocortisone hemisuccinate 0.025 G, lidase 64 UE in 50 ml 0.25% novocaine solution) in combination with ultrasound therapy, vibration massage, zinc, and then resort treatment is prescribed. To prevent adhesions after operations for inflammatory formations, zinc electrophoresis is indicated in low frequency mode (50 Hz). To prevent relapse of endometriosis, electrophoresis of zinc and iodine is performed, sinusoidal modulating currents, and pulsed ultrasound are prescribed. Procedures are prescribed after 1-2 days. After operations on the uterine appendages for inflammatory formations, ectopic pregnancy, benign ovarian formations, after organ-preserving operations on the uterus and supravaginal amputation of the uterus due to fibroids, patients remain disabled for an average of 30-40 days, after hysterectomy - 40-60 days. Then they carry out an examination of their ability to work and give recommendations, if necessary, to exclude contact with occupational hazards (vibration, exposure to chemicals, etc.). Patients remain on dispensary registration for 1-2 years or more.

Outpatient treatment after obstetric surgery depends on the nature of the obstetric pathology that caused surgical delivery. After vaginal and abdominal operations (fertility operations, manual examination of the uterine cavity), postpartum women receive a period of 70 days. An examination in the antenatal clinic is carried out immediately after discharge from the hospital; in the future, the frequency of examinations depends on the particular course of the postoperative (postpartum) period. Before being removed from the dispensary registration for pregnancy (i.e. by the 70th day), the following is carried out. If the reason for operative delivery is extragenital, an examination by a therapist, and, if indicated, by other specialists, and a clinical and laboratory examination are required. A complex of rehabilitation measures is carried out, which includes general strengthening procedures, physiotherapy, taking into account the nature of somatic, obstetric pathology, and the peculiarities of the course of P. p. For purulent-inflammatory complications, zinc electrophoresis is prescribed with diadynamic low-frequency currents, in a pulsed mode; for postpartum women who have suffered from concomitant kidney pathology, pulsed ultrasound is indicated for the area of ​​the kidneys, the collar zone according to Shcherbak. Since even during lactation it is possible 2-3 months after birth, contraception is mandatory. Wounds and wound infection, ed. M.I. Kuzina and B.M. Kostyuchenok, M., 1981; Guide to eye surgery, ed. L.M. Krasnova, M., 1976; Guide to neurotraumatology, ed. A.I. Arutyunova, parts 1-2, M., 1978-1979; Sokov L.P. Course of traumatology and orthopedics, p. 18, M., 1985; Strugatsky V.M. Physical factors in obstetrics and gynecology, p. 190, M., 1981; Tkachenko S.S. , With. 17, L., 1987; Hartig V. Modern infusion therapy, trans. from English, M., 1982; Shmeleva V.V. , M., 1981; Yumashev G.S. , With. 127, M., 1983.

1. Small medical encyclopedia. - M.: Medical encyclopedia. 1991-96 2. First aid. - M.: Great Russian Encyclopedia. 1994 3. Encyclopedic Dictionary of Medical Terms. - M.: Soviet Encyclopedia. - 1982-1984.

The period of treatment for a patient from the end of the surgical operation to its fully determined outcome... Large medical dictionary

Occurring after surgery; this term is applied to the patient's condition or to his treatment carried out during this period.