On what day after the operation can you eat. Food after surgery. Do I need to remove the gallbladder

The gallbladder is involved in the digestion of food. The organ is pear-shaped, located under the liver. The main functions are the accumulation (deposition) and excretion of fluid secreted by the liver. Bile helps in the absorption of fats in the body and activates the stomach.

Cholecystectomy is surgical. The entire organ is excised by surgery. Without it, people lead their usual way of life, observing the rules of nutrition.

The gallbladder, during normal functioning, plays an important role in the digestion of food. In the case of pathological processes occurring in the organ, it causes a lot of inconvenience: worsens the state of health and health. Symptoms appear:

• Stomach ache;
• Stool disorder;
• Nausea and vomiting;
• Increased body temperature, etc.

• Cholelithiasis (gallstone disease). It proceeds with severe symptoms in the form of acute pain in the stomach, high temperature, profuse vomiting.
• Acute cholecystitis. A person experiences a feeling of nausea, vomiting, fever, cramps in the abdomen, bitterness in the mouth.
• Choledocholithiasis is a type of gallstone disease.
• Education.

With these diagnoses, the patient needs surgical medical intervention. When removing an organ, modern medicine performs cholecystectomy using the method of laparoscopy. The duration of the operation is from 30 minutes to 1.5 hours. The surgical method allows you to perform an operation that reduces the time for rehabilitation after removal of the gallbladder and helps to avoid postoperative consequences.

Postoperative period

After removing the organ, the patient is immediately transferred to the intensive care unit and provided with proper care. The patient must remain in the hospital until he recovers. Complications are possible with cholecystectomy. Today, the operation is performed laparoscopically, complications and unwanted consequences are minimized. The first time (12-24 hours) you can not get out of bed, eat and drink. If you need to get up, you need to move with the support of medical personnel. Dizziness and fainting are possible after anesthesia. The recovery period lasts 7 days. After 10 days, if the condition is satisfactory, the patient is discharged.

A person who has had their gallbladder cut out should follow these tips:

• Do not break the dietary table, observe the diet. Healthy food, balanced dietary menu is an important part of the body's recovery process. The diet must be followed for life. goal diet food - stimulate the withdrawal of bile from the body, stabilize the metabolism. If the patient does not adhere to the doctor's recommendations on nutrition, cholecystitis attacks are possible.
• The use of drugs. Drug therapy helps a person adapt to live without a gallbladder. The patient is prescribed hepatoprotectors - a class of drugs that perform a protective function of the liver. Six months later, the body recovers after laparoscopic cholecystectomy.
• Exercise. Massage gymnastics for the abdomen (two months). The first time you need to do the exercises under the supervision of a doctor. It is recommended to limit physical activity for a month.

Three important rules will help the body adapt to life after surgery, improve health faster and normalize the functioning of the digestive tract. Failure to comply with the prescriptions of the attending physician will negatively affect health.

Diet after surgery

Nutrition after cholecystectomy is aimed at restoring metabolic processes in the body, the food should be healthy, gentle for the stomach. Before preparing for surgery, it is important for a person to tune in to changes in their usual diet and restrictions in the first month.

Food table (permitted and prohibited) after cholecystectomy

Despite the restrictions, the meal of a person with a gallbladder removed remains balanced. The body needs constant replenishment of nutrients, useful microelements. Proper nutrition - a guarantee of quick recovery. There is a lack of appetite after the operation. It is important to inform your doctor about this.

In order to competently approach the rehabilitation period and adaptation of the stomach after cholecystectomy, it is important to know which foods are allowed to be consumed and which are strictly prohibited.

The menu is allowed to include:

Fresh fruits and vegetables are prohibited. They provoke increased bile secretion.

Prohibited Products

The list of foods that can disrupt the activity of the digestive tract - form the appearance of abdominal cramps, create an excessive load on the digestive process:

If you exclude the listed foods, you can avoid unpleasant consequences and complications. After a year, some foods from the list of prohibited foods can be introduced into the diet; a daily diet is used. Meals are discussed with the attending physician.

Approximate dietary menu after laparoscopic cholecystectomy

There are many options for a balanced diet after surgery. Knowing how to properly prepare the permitted products, you can make your meals healthy, tasty, and varied. Make a menu for the week. Use different ways cooking. A strict diet will help to cope with gastrointestinal pathologies, overweight, and improve health. Remember! Portions should be small (200 g), food fractional (6 times a day), the volume of water drunk is not more than 2 liters. After 3 months, almost all vegetables and fruits are added to the menu.

Consider the diet after laparoscopic cholecystectomy and examples.

Option 1:

• Breakfast. Prepare oatmeal for your morning meal. It is allowed to add a piece of butter to porridge, rye bread. It is recommended to drink green tea (you can make decoctions from medicinal plants).
• Lunch. Grated apples without peel.
• Dinner. Chicken soup with vegetables (carrots, potatoes, broccoli, chicken fillet, parsley, a little salt). Bread with cheese (hard cheese, low-fat), compote from a mixture of dried fruits.
• Afternoon snack. Kissel with crackers, bananas.
• Dinner. Prepare minced fish cutlets on a steam bath. Curd casserole, compote.
• Second supper. At night, you can drink a glass of yogurt.

Option 2:

• Breakfast. Make protein omelet (separate yolk). Make rosehip decoction.
• Lunch. Apricots are good for a snack.
• Dinner. Diet vegetable soup ( cauliflower, carrots, bell peppers, salt). For the second, cook cod liver. Oat cookies for dessert, warmed milk.
• Afternoon snack. Yesterday's bread (crackers), cheese, compote.
• Dinner. Cooking pasta with gravy. Tea with milk. For dessert dates, raisins or marshmallows.
• Second supper. A portion of low-fat cottage cheese.

Option 3:

• Breakfast. Millet porridge, juice.
• Lunch. Diet yogurt.
• Dinner. Soup (champignons, potatoes, herbs). Unsweetened cookies, compote.
• Afternoon snack. Steamed zucchini, tea with mint.
• Dinner. Boil shrimps, make mashed potatoes. For dessert, fruit jelly and tea.
• Second supper. A glass of fermented baked milk and crackers.

Option 4:

• Breakfast. Buckwheat porridge, herbal tea and soufflé (you can add raspberries, the berry activates the digestion process).
• Lunch. Dairy products (kefir, yogurt).
• Dinner. Cook fish in a steam bath, make a salad. Drink a glass of juice.
• Afternoon snack. Boiled corn, compote.
• Dinner. It is allowed to cook pizza using approved products for the filling. As a dessert tea with marshmallow.
• Second supper. Light salads will do.

Option 5:

• Breakfast. Diet cottage cheese (you can grind in a blender, add some dried apricots), green tea.
• Lunch. Banana.
• Dinner. Mashed potatoes with fish cakes. Marshmallow, tea.
• Afternoon snack. Sandwich, rosehip decoction.
• Dinner. Seafood soup. Jelly tea.
• Second supper. Dried apricots, raisins.

It is not recommended to use the first time tomato juice... It is supposed to eat, strictly observing the prescription and recommendations of the doctor. The duration of treatment and eating behavior are assigned individually. In order for the recovery period to pass quickly and without complications, lead a healthy lifestyle.

When a person successfully undergoes surgical treatment, a recovery period begins. Many people immediately have questions: what can you eat after the operation? How long after the operation can I eat? In most cases, for this period, the patient is assigned a certain diet, which provides answers to these questions. Strict adherence to such a diet is an extremely important factor for a successful rehabilitation process.

Most often, dietary food requires a fractional intake principle, in small, but actively repeated portions. On what day after the operation can you eat and follow the dietary regimen? Usually, you can eat on the third day after the successful operation, but each surgical treatment has its own characteristics.

Diets vary in nature, depending on the type of surgery. Below is a description of the key cases and the corresponding diets.

Types of operations

The key types of operations to which a diet can be assigned are divided according to the actions performed:

1. Cavity treatment.
2. Treatment of the gallbladder.
3. Bowel treatment.
4. Elimination of appendicitis.
5. Stomach treatment.
6. Elimination of the uterus.

What can you eat after surgery from this list? Below is a detailed description.

The main task: saturating the body with the necessary nutrients and reducing the load on the body, both as a whole and on the cavity for which the operation was performed.

Food composition:

• sweetened tea (lemon is optional);
• rosehip drink;
• freshly squeezed juices, jelly;
• jelly from fruits and berries;
• fat-free meat broth;
• boiled rice water.

The principle of food intake: eat small portions, up to seven times a day.

This diet is the main food after surgery and includes several types: A, B and C.

The description of the 0A diet is given above, the calorie indicator per day is no more than 780 kcal.

The 0B diet differs in that the dietary food includes low-fat cream, berry mousses, jellies (non-acidic), cereals in a liquid and pureed form, as well as boiled cereal soups seasoned with chopped boiled vegetables or not too fatty chicken broth. If there are no contraindications, then add a protein omelet or meat soufflé (steam cooking principle). The principle of taking a diet of this type: no more than 380 grams, up to six times a day, the calorie index per day is no more than 1600 kcal.

The 0B diet is unlike the previous ones in that the medical nutrition after the operation additionally contains grated boiled meat and chicken products, lean fish, vegetable puree, porridge with milk (liquid type), grated cottage cheese (with the addition of cream), kefir, baked apple products and white crackers. The calorie indicator per day is no more than 2200 kcal.

What foods are contraindicated? These include the following:

1. fatty meat, poultry and fish;
2. strong vegetable broths;
3. fresh baked goods;
4. salted and smoked products;
5. canned foods;
6. hot sauces and condiments.

Goal: to limit the consumption of junk food.

Term: up to three months.

• lean meats and fish;
• weak meat and vegetable broths;
• dried bread;
• fermented milk products (fat-free type).

The principle of food intake: take in small portions, rely on the fractional principle of nutrition, up to five times a day.

This diet after surgery assumes a fractional principle of food intake. Patients who eat according to the principles of the diet should receive at least 80 grams of protein and fat and no more than 400 grams of carbohydrates. The calorie indicator per day is no more than 2500 kcal.

The following products are prohibited:

1. strong broths (meat and fish);
2. fatty meats and fish;
3. food that is too hot or too cold.

Purpose: to exclude coarse vegetable fiber and indigestible foods from the human diet. This postoperative diet can help reduce gastrointestinal contraction and flatulence.

Term: up to one month.

What to eat after this type of surgery?

The composition of the diet will be as follows:

• grated porridge (for example, buckwheat);
• boiled vegetable broth;
• light egg dishes;
• jelly and jelly (from apples, pears, quince);
• low alcohol drinks (non-alcoholic);
• coffee without milk.

The principle of food intake: use small fractional portions.

Such postoperative nutrition, according to this diet, is based on fractional food intake and is based on liquid homogenized food, which is easily absorbed by the human body.

Foods to avoid:

1. legumes;
2. pasta;
3. drinks with gas;
4. vegetables and fruits;
5. dairy products and dishes containing dairy products (except for cottage cheese);
6. bakery products (except for rusks from wheat bread);
7. meat soups (except for steamed meatballs or chopped boiled meat);
8. fatty type of meat products;
9. oily or salted fish;
10. fats (only a little butter can be put in ready-made dishes).

Purpose: saturation of the body with useful substances through the use of easily digestible food.

Term: up to 14 days.

What to eat after this type of surgery?

The composition of the diet will be as follows:

• low-fat broth;
• vegetable broth;
• rice broth;
• puree soups or liquid character;
• boiled and stewed vegetables.

The principle of food intake: fractional meals, up to 8 times a day.

This postoperative nutrition contributes to the rapid recovery of the body due to the prompt receipt of the necessary nutrients.

1. raw vegetables and fruits;
2. dishes with legumes;
3. dairy;
4. fried food;
5. spicy and salty foods;
6. too strong drinks.

The purpose of the diet: a gentle regimen for the body, relieving stress and gradually getting used to difficult-to-digest foods.

Diet term: up to one month.

Diet composition:

• low-fat broths;
• milk or fruit jelly;
• jelly (fruit);
• cream less than 2% fat;
• boiled soups;
• soft-boiled eggs;
• carrot juice;
• non-acidic fruit juices.

The principle of food intake: take in small portions, up to seven times a day.

Nutrition in the postoperative period includes the principles of the diet used in the treatment of the cavity, and already on the eighth day, the above differences come into the diet.

Prohibited foods include the following:

1. spicy, salty and fried foods;
2. sour fruit drinks;
3. carbonated drinks;
4. fatty dairy products.

The purpose of the diet: indulgence for the stomach, gradually bringing the body to the intake of more complex food.

Diet term: up to one month.

Diet composition:

• fermented milk products;
• cereal dishes;
• low-fat broths;
• boiled meat;
• light vegetable salads.

Food intake principle: food after surgery is taken in small portions, up to seven times a day.

Food after gynecological surgery of this type controls the amount of fluid consumed and selects a gentle diet for the patient, which allows the body to prepare the body for the progressive intake of more complex food.

Why can't I eat certain foods after surgery? This can strain the stomach and worsen the general condition of the body. In order to avoid this, you should not eat such foods:

1. salty, spicy and fatty foods;
2. pasta;
3. fried food:
4. meals containing legumes;
5. bakery products;
6. strong alcohol;
7. chocolate.

This article examined some of the most common operations and short description appropriate diets to them. Following this description will speed up the positive rehabilitation of the body during the recovery period.

Operations related to the gastrointestinal tract are familiar to many. Within the hospital, patients necessarily follow a diet, but after discharge they often neglect it, which is why they again experience pain and malaise. But the diet must be followed for a long time after discharge from the hospital.

Surgical intervention in the abdominal cavity has consequences. This is especially true of the abdominal organs. Adhesions are formed in the intestines, which indicate obstruction.

In the first days of rehabilitation, the patient is recommended to drink plenty of fluids, as well as soups, vegetable purees and juices, decoctions, cereals. Vegetables are especially useful due to the presence of fiber, which is required by the intestines to restore proper functioning.

1. For two days after the operation, the patient is prescribed hunger. However, nutrients enter the body with the introduction of solutions intravenously.
2. For 14 days, a person should eat sparing, liquid food.
3. Further food intake involves steaming or boiling, after which it is recommended to grind the cooked food into porridge.
4. It is recommended to stick to a diet after surgery for 30 days.
5. During this period, it is forbidden to eat junk food, more animal protein should be included in the diet.
6. Food intake should take place strictly at the same time.
7. Fractional food. It is recommended to eat 5-6 times a day, and the serving volume is 100 ml. It is recommended to eat once every 2.5 hours.
8. Dishes should be warm.
9. It is recommended to include fermented milk products in the diet.

What foods are prohibited?

The correct diet after surgery on the gastrointestinal tract involves avoiding harmful foods, which include:

1. Legumes, mushrooms and nuts. These products provoke the development of peritonitis.
2. White and cauliflower, kohlrabi.
3. Grapes, sour apples, pears and citrus fruits.
4. Products made with yeast.
5. Sweet and flour products.
6. Carbonated drinks.
7. Alcohol.

The dietary ration for patients prohibits the use of fried, salty, peppery, smoked foods. Also, you cannot use various sauces and spices for cooking and dressing dishes.

Important information! During the rehabilitation period, coffee has a beneficial effect. However, before you start drinking the drink, you should get permission from your doctor.

The essence of the diet is to regulate the patient's stool, peristalsis and relieve pain in the intestines. A properly formulated diet does not load the gastrointestinal tract, which is why tissue repair proceeds faster. The rehabilitation period lasts less.

Foods permitted after surgery

It is allowed to take food that does not burden or irritate the intestines. These products include:

• cereals;
• non-acidic vegetables and fruits;
• fermented milk products;
• food rich in animal protein;
• eggs;
• juices, compotes, decoctions;
• crackers.

Patient's menu after bowel obstruction surgery

The cause of intestinal obstruction is organic tumor lesions. Because of this, it is recommended that you approach your diet with caution.

Doctors determine the factors of occurrence of the disease and methods of their elimination. Strict adherence to the diet is recommended for quality treatment.

The menu structure after this operation provides for the use of products:

• rosehip decoctions;
• unrefined vegetable oil;
• raisins, prunes;
• fermented milk products.

Note! Food should be served warm immediately after cooking.

The postoperative diet includes the following mandatory requirements:

• it is forbidden to heat food in a microwave oven;
• complete rejection of preservatives;
• it is forbidden to use products containing artificial flavors and colors;
• it is recommended to abandon salt completely, in extreme cases, to reduce its consumption to a minimum.

Do not eat or drink for 12 hours after the surgeon performed the operation. It is required to consume useful and nutrients in the form of intravenous solutions.

This diet has a beneficial effect on the human intestines. All food that enters the body must be absorbed without hindrance. Portions should be reduced and divided into 5 or 6 meals a day.

In addition to the obligatory food products, the patient should consume 2 liters of water per day, and the food needs to be wiped or turned into pulp.

Video - Proper nutrition after removal of an intestinal tumor

Diet after colon cancer surgery

A well-designed patient menu after surgery on the human intestine helps to accelerate the recovery and functioning of the digestive tract. However, there is no special diet. The doctor himself makes a menu for the patient, based on the indications. A mandatory requirement in the diet is the presence of fruits and vegetables. And it is recommended to exclude junk food. The method for preparing food is the same as for any diet after surgery in the abdominal cavity.

Any surgical intervention in the human intestine impairs the absorption of beneficial components. To normalize this process, you should take non-heavy food that does not irritate the digestive tract.

Compulsory requirements include calm chewing of food. You can't eat on the go. It is also recommended to split your diet into 5-6 meals a day. Portions should be reduced.

Important information!In case of constipation, it is recommended to consult a doctor.

Approximate diet for a week

When the patient is in the hospital, the dietitian draws up the menu. At this time, the patient should not bring other food, as this harms the gastrointestinal tract.

After a person has left the hospital, a diet is developed at home on the recommendation of a doctor.

One of the homemade weekly diet options after bowel surgery:

Day	The diet	Picture
The first	for lunch - light soup and compote; for dinner - compote and fish soufflé; before going to bed a mug of kefir
Second	From 7 to 8 am - rice porridge on the water and green tea; from 10.00 to 11.00 pm - fruit; for lunch - a light vegetable soup, crackers and compote; 16.00 to 17.00 - fruit drinks and berries; for dinner - cottage cheese casserole with honey and tea; before bed - rosehip decoction
Third	From 7 to 8 am - buckwheat porridge on the water and green tea; from 10.00 to 11.00 in the afternoon - fruit; for lunch - light fish soup and compote; 16.00 – 17.00 - boiled egg and crackers; for dinner - mashed potatoes with minced meat; before bed - 250 ml of natural yogurt
Fourth	From 7 to 8 am - oatmeal in the water and green tea; from 10.00 to 11.00 in the afternoon - steamed egg white omelet; for lunch - light pumpkin soup and compote with breadcrumbs; 16.00 -17.00 - fruit and a glass of tea; for dinner - mashed potatoes, steamed meatballs and a glass of tea; before going to bed a mug of kefir
Fifth	From 7 to 8 am - pearl barley porridge and black tea; from 10.00 to 11.00 in the afternoon - boiled egg; for lunch - chicken soup and compote; 16.00-17.00 - fruit; · 18.00 –19.00 - jelly and meat soufflé; before going to bed a mug of kefir
Sixth	From 7 to 8 am - egg white omelet, crackers and tea; from 10.00 to 11.00 pm - berries; for lunch - light rice soup and compote; 16.00 - 17.00 - fruit and a glass of tea; for dinner - mashed potatoes, steamed meat cutlet and jelly; before going to bed rosehip decoction
Seventh	From 7 to 8 am - rice porridge on the water and compote; from 10.00 to 11.00 in the afternoon - boiled egg and crackers; for lunch - light soup with vegetables and compote; 16.00 -17.00 - cottage cheese with 0% fat and a glass of tea; for dinner - vegetable stew and jelly; natural yogurt before bed

Video - Super food after surgery

What are the dietary requirements?

The diet after bowel surgery includes a specific diet. However, there are some tips for making it at home:

• crackers should be made from wheat bread;
• to cook porridge in water or skim milk;
• meat and fish need to be processed into minced meat before cooking;
• eggs are recommended to be eaten soft-boiled or in the form of a steam omelet;
• dairy products should be with a minimum percentage of fat.

After a week, it is allowed to include more foods in the diet, but it is important to remember that they need to be steamed, boiled or stewed, since the intestines are only getting used to normal food.

A properly formulated diet for the rehabilitation period will reduce the load on the gastrointestinal tract and accelerate the course of recovery. It is especially important to adhere to the diet after discharge from the hospital.

The most important thing to consider after bowel surgery is the methods traditional medicine caution is advised.

Diet after gastric resection plays an important role in the recovery of the body. In the postoperative period, the patient will have to completely change his eating habits. The diet must be balanced, because resection of the stomach often provokes a sharp weight loss, which is undesirable, since it is additional stress for the diseased body.

Importance and goals of the diet

After a gastrectomy during the rehabilitation period, it is important to eat properly so that further recovery takes place without complications. The postoperative diet aims to heal the rest of the stomach quickly, because during this period, eating habits can worsen the condition. Sample menu, permitted products and recipes for cooking dishes must be approved by a gastroenterologist. After a gastrectomy, it is difficult for the patient to recover, and he quickly loses weight. Therefore, another goal that the diet pursues after removal of the stomach is not to bring the patient to exhaustion and to maintain his weight within normal limits.

After resection of the stomach for cancer or any other severe pathology, the anatomy of the digestive organ changes, and the conditions in which food will normally be digested change accordingly. Rehabilitation nutrition after the removal of a part of an organ allows the body to gradually adapt to new conditions, thereby minimizing the risk of dangerous complications.

Features of nutrition in the early postoperative period

In the first 2-3 days of the postoperative period, it is forbidden to take any food.

In the first 2-3 days after surgery, regardless of the indications and the handicap of the pathology, it is prohibited to take any food. Sometimes restrictions are imposed on water, but here the doctor decides everything. When early risk postoperative complications passes and in the absence of contraindications, you can begin to take liquid in the form of vegetable broth, jelly. Then the food, grated to a puree-like state, kefir, curd soufflé are added to the diet.

New dishes are added after a week. It is recommended to feed a person with mashed potatoes, boiled or steam meat dishes, half-grated vegetable soups. And also freshly squeezed juices, some crackers or dryers, dried bread are allowed. With the stomach removed, food is prepared in a gentle way, without the use of salt, spices and seasonings.

After 3 months, the food after stomach surgery is expanded. You can eat half-grated food, but it is important to chew each piece thoroughly, in addition, special attention is paid to the use of liquid, which has a beneficial effect on digestion. After 6 months, you can eat most of the usual foods and dishes, but you should adhere to the rules of separate nutrition and try not to mix foods of different composition.

Further diet

Despite some dietary restrictions, patients will not starve after the operation, because the dietary table contains a lot of delicious and healthy food, however, the method of preparation is different from the usual one. It is useful to eat fractionally, 4-6 times a day, while the break between meals should not exceed 3-3.5 hours. Dishes are steamed or boiled. Frying in oil or adding frying to prepared food is strictly prohibited.

To speed up the recovery of the stomach after surgical treatment, in addition to diet, the doctor may advise the use of natural dietary supplements. The regimen of admission must be determined by a gastroenterologist. It is dangerous to use such additives on your own.

What can you eat?

Boiled eggs must be added to your diet.

The diet after resection of the stomach for oncology or ulcerative lesions will be strict, however, the list of permitted foods is not meager, so a person will not starve. The menu must include the following food:

• Boiled eggs or in the form of a steam omelet;
• Lean meats - veal, chicken, turkey;
• Lean fish;
• Vegetable oil - olive, linseed, sunflower;
• Dairy and sour milk products of medium fat content;
• Hard cheeses, but not too salty and without hot spices;
• Vegetables - potatoes, carrots, pumpkin, zucchini, beets, broccoli;
• Fruits - sweet apples, plums, pears, strawberries;
• Vegetarian soups;
• Nuts, peanuts, dried fruits;
• Liquid and viscous porridge on the water - buckwheat, rice, oatmeal.

It is allowed to add butter to mashed potatoes - about 10 g, and it is also useful to eat a sandwich with butter and cheese in the morning. As a dessert, you can cook cottage cheese casseroles or bake sweet fruits in the oven - an apple, a pear. Porridges are cooked only in water, if desired, you can add a little milk and butter to the finished dish. As a drink, it is recommended to use green tea with milk, dried fruit compotes, herbal teas and infusions of chamomile, St. John's wort, mint, rose hips.

Non-specialized information. The postoperative period is possibly divided into early and late. The first of them lasts about three to four days and generally ends by the time the intestines act; the second follows the first and ends in 12-20 days, in other words, by the day of discharge. The period following the discharge, ending with the restoration of working capacity, is possibly called the period of convalescence; its duration is different.

In order to better monitor the wound (from time to time, in addition to the contraction of the uterus), at the end of the laparotomy, it is better not to bandage the belly, but to apply a bandage of several layers of gauze reinforced with strips of sticky plaster.

At the end of the operation, the patient is placed in the recovery room under the supervision of the duty officer or a designated nurse.

Recovery wards should have one to three beds and be located close to the operating room and the duty post. Only at the end of small gynecological operations, it is possible for patients to be placed in wards with four to six beds, intended, but, in addition, for relatively recently underwent surgery.

The operated patient is placed on a bed prepared in advance and warmed up. If necessary, the patient is warmed with heating pads, heart, glucose, saline, etc. are injected. At the end of the belly, an ice pack is placed to reduce pain in the wound and to prevent hematoma. In case of vomiting at the end of anesthesia, a bowl, a mouth dilator, a towel should be ready; the patient lies without a pillow, the head is turned to the side so that there is no aspiration of vomit. In obese people, it is useful to wrap the belly over the bandage with a special towel with ties at the front (gurita).

In recovery wards, you need to have oxygen ready, which is used at the first indicators of cyanosis, increased frequency or shallow breathing. Measurement blood pressure create, like the pulse count, a couple of times during the first six to eight hours after the end of the operation.

Within three to six hours after the end of the operation, pain appears in the wound area. Pain can also occur at the end of small operations, for example, at the end of colpoperineorrhaphy.

Postoperative pain must be eliminated, because, in addition to anxiety, insomnia and worsening of a non-specialized state, they can lead to secondary: flatulence, urinary retention, etc. The negative effect of postoperative pain on the central nervous system has been proven; some surgeons see them as a circumstance for the development of shock and postoperative psychoses.

With an early onset of pain, promedol 2% 1-2 ml is prescribed subcutaneously, and at night morphine 1% 1 ml or pantopon 2% 1 ml subcutaneously.

Some authors use chlorpromazine for pain in the postoperative period. The drug can be administered intravenously or intramuscularly (2 ml of a 2.5% solution), and 0.025 orally, 1 pill 3 times a day the next day after the end of the operation. At the end of the administration of chlorpromazine, blood pressure decreases for a short time.

Vomiting at the end of anesthesia in operated patients is noted quite often and depends on irritation of the gastric mucosa by a narcotic substance. It is recommended not to prescribe anything internally; on the epigastric area - heating pads. In case of vomiting at the end of spinal anesthesia, 1-2 ml of 10% caffeine is injected subcutaneously two to three times in the first days.

Urination should be achieved no later than 12 hours after the end of the operation. If the patient is unable to urinate herself (in a heated vessel), then urine is produced by a catheter in compliance with all aseptic rules. If urination is delayed in the following days, special measures are required.

The usual postoperative period. Nutrition. In the absence of contraindications - vomiting, post-anesthetic sleep, unconsciousness - a patient who underwent surgery under non-specialized anesthesia, after 3-4 hours (not earlier than 1-2 hours, after the cessation of vomiting) is allowed to drink, more optimal is warm strong tea with lemon. At the end of a large blood loss, it is necessary to re-give a lot of fluid: to be directed to emphasize that in these patients vomiting at the end of anesthesia is noted less often, based on this, they need to start allowing them to drink earlier. It is extremely important to force the operated patient to breathe deeply almost immediately after awakening from anesthesia to remove the remains of ether from the lungs (breathing exercises).

Those who have undergone surgery under spinal or local anesthesia can be allowed to drink after 15-20 minutes. at the end of the operation; it quenches thirst, regulates water exchange and, in addition, has a positive effect on the psyche of patients.

In order to avoid acidosis, already on the day of the operation, it is possible to start feeding patients, and their food regime is contained in a liquid and semi-liquid diet: sweet tea, broth, jelly, vitamins, milk; the next day in the morning - sweet tea, crackers; on the second and third days, they add porridge (rice, semolina), crackers, a roll, butter; from time to time, to stimulate the appetite of not strong patients from the fourth or fifth day, it is useful to prescribe in a small amount of protein substances - caviar, ham. At the end of the one-two-fold bowel action, the patients are transferred to a non-specialized table.

From the very beginning of the operation, you need to monitor the cleanliness of the mouth and tongue (rinsing with a not strong solution of potassium permanganate, cleaning the tongue by a mechanical method - gauze wrapped on a spatula).

Bowel regulation. At the end of the laparotomy, if the effect of the intestine does not occur spontaneously, a hypertonic or glycerin enema is prescribed for three days.

If the intestines do not work, a cleansing enema of 1 liter of water (with soap) is prescribed or a saline laxative is given.

At the end of vaginal operations with sutures on the perineum, in order to prevent injury to the perineum, it is better to prescribe a laxative instead of an enema, but not earlier than four days after the end of the operation.

Removal of stitches. At the end of the laparotomy, the braces are removed for a week, silk sutures - for the eighth. The stitches on the perineum at the end of plastic surgery are removed early - by five days, since later removal of the stitches can cause them to erupt.

Postoperative complications. Shock (defeat nervous system) is seen at the end of gynecological operations more often than at the end of obstetric operations, which is partially explained by the shorter duration of obstetric operations and anesthesia during them. In gynecological practice, shock can appear at the end of huge long operations (for example, at the end of an extended extirpation of the uterus for cervical cancer). Collapse (damage to the vascular system, vasomotors) is more often seen in obstetric pathology and at the end of obstetric operations, especially those associated with large blood loss.

Clinically, shock and collapse are very similar, but in shock, consciousness in most cases remains, in collapse it is dim; in shock, the color of the integument is pale yellow, dull; with collapse and blood loss, the skin is pale to a marble-shiny whiteness.

In case of shock and collapse, patients are laid with a pair of lowered head, they are covered with heating pads; under the skin or into a vein, cardiac agents are injected - camphor (subcutaneously), caffeine, strophanthin, strychnine. Especially advise adrenaline 1. 1000-0.5 ml intramuscularly or into a vein; due to the shortness of the action of adrenaline, it is necessary to re-inject it at 0.1-0.2 ml. Instead of adrenaline, it is possible to use pituitrin subcutaneously. It tones blood vessels and has a longer lasting effect than adrenaline. To irritate the vasomotor center, it is recommended to inhale carbon dioxide, more optimally in the form of a mixture (if there is a special apparatus) of 10% carbon dioxide, 50% oxygen and 40% air. In the future, glucose is administered with adrenaline (intravenous drip method) or some kind of anti-shock fluid. With a large blood loss and shock, a good remedy is a blood transfusion (after the restoration of correct blood circulation) in large quantities (up to 1 liter), preferably in two steps.

Secondary bleeding in the trunk can be observed at the end of the laparotomy, less often at the end of the vaginal removal of the uterus, much more often when the ligature slides off the vascular stump; they are manifested by symptoms of internal bleeding. The only correct therapy in these circumstances is urgent relaparotomy and ligation of bleeding vessels.

With vaginal surgery, secondary bleeding will also occur, in most cases through the vagina. In these circumstances, it is possible to damp the latter with gauze. If this does not help, you need to well expose the bleeding area with mirrors, find the bleeding vessel and ligate it.

Vomiting in the postoperative period is not uncommon of various origins, based on this and its treatment depends on the circumstances that caused it.

Vomiting at the end of inhalation anesthesia on the initial day after the end of the operation was discussed above. Vomiting, which appears later, is possibly an indicator of acute expansion of the stomach, beginning peritonitis or intestinal obstruction. In the best way treatment of vomiting there is rest for the stomach; no food or medicine needs to be administered through the stomach. Against dehydration, subcutaneous infusions or drip enemas are prescribed. It is possible to put a heating pad on the stomach area. With a huge accumulation of mucus, the stomach is washed with a probe with a solution of soda mixed with a few drops of mint tincture, or a long Bukatko wash is prescribed. In case of vomiting at the end of spinal anesthesia, it is useful to inject 10% caffeine under the skin two to three times a day, 1 ml.

If vomiting is associated with non-evacuation of gases, it is possible to first apply gastric lavage, inject a hypertonic NaCl solution (10% 50-100 ml) into the vein, and prescribe siphon enemas. In case of vomiting, depending on the incipient peritonitis, the stomach is washed, and penicillin is injected (intramuscularly, 150,000 IU after three hours). If there is no result, in both cases, they immediately proceed to (repeated) gluttony.

The circumstance of flatulence at the end of laparotomy is the exposure, cooling and trauma of internal organs associated with the operation, and the negative effect of non-specialized anesthesia. Rapidly performed operations, especially without the use of non-specialized anesthesia, rarely give postoperative intestinal paresis. In gynecology, postoperative flatulence is much more often observed with intra-abdominal bleeding or with flow of pus and contents of cystic tumors in the trunk. By the beginning of the third days, flatulence in most cases passes.

Prevention of this complication, painful for the operated patients, is contained in a careful surgical regulations, operating with protection abdominal organs, especially the intestines, from the ingress of pus, careful handling of the peritoneum and intestinal loops. Preparation of patients for laparotomy by the method of prescribing laxatives is usually unnecessary, since they increase intestinal paresis.

An uncomplicated remedy against flatulence is the introduction of a tube into the rectum (12-15 cm), which immediately eliminates one of the circumstances of flatulence - spasm of the sphincter. It is great to combine tube insertion with thermal procedures, for example, an electric light bath (recommended by Gelinsky). But vigorous warmth may be contraindicated in patients with a tendency to uterine bleeding. To excite intestinal peristalsis, many surgeons and gynecologists use physostigmine subcutaneously, 0.5-1 ml of a 0.1% solution. It is possible to enter it prophylactically even on the operating table, and in days after the end of the operation, prescribe a glycerin enema.

Most often, physostigmine is prescribed under the skin once or twice a day in combination with a gas tube and a dry air bath. If this drug is not at hand, it can be successfully replaced with pituitrin. The effect of pituitrin, in addition to stimulating intestinal peristalsis, is very useful in other respects: it raises blood pressure, promotes urination, which is usually not uncommon. Pituitrin is administered at 0.5-1 ml twice a day under the skin.

As for enemas, it is possible to advise them at the end of the days at the end of the operation in the form of microclysters from a hypertonic solution of sodium chloride (10% 100 ml) or much better in the form of glycerin enemas (one or two tablespoons of glycerin per 1/2 glass of water). The pure, undiluted glycerin enemas recommended by some are very irritating to the rectal mucosa. If hypertensive, glycerin or simple enemas do not work, they switch to siphon enemas by introducing a rubber tube above the internal sphincter; siphon enemas from a hypertonic (10%) solution of sodium chloride are also very effective.

Most often, postoperative pneumonia and bronchitis are seen at the end of laparotomy, especially long-term and performed under non-specialized inhalation anesthesia (aspiration lobular pneumonia). But in addition, vaginal operations carried out without inhalation anesthesia can be complicated by bronchitis and pneumonia. To a greater extent, postoperative bronchitis and pneumonia may be helped by pelvic vein thrombosis at the end of vaginal operations. Nevertheless, abstaining from inhalation anesthesia in favor of local or spinal anesthesia, without a doubt, reduces the frequency and severity of postoperative complications in the lungs.

Prevention of pneumonia and bronchitis is contained in protecting patients from cooling, for example, during sanitation. It is better to operate patients with bronchitis, emphysema, pulmonary tuberculosis not under ether anesthesia, but under local anesthesia or thiopental sodium intravenous drip anesthesia. To reduce the secretion of mucus from the respiratory tract, it is advisable to inject 1 ml of atropine under the skin under anesthesia before the operation.

At the end of the awakening, the patient is offered to take deep breaths (breathing exercises), prescribe (prophylactically) circular cups on the chest, heart funds under the skin, high position of the upper body (in the absence of contraindications - anemia - and only four to six hours after the end of the operation) ... Those operated from the very beginning should be directed to turn from one side to another and not be allowed to lie on their backs for a long time.

Modern treatment of already developed pneumonia is performed according to non-specialized schemes with the use of sulfa drugs in huge doses, penicillin and streptomycin.

Retention of urination can be observed both at the end of the laparotomy and at the end of vaginal operations. Postoperative urinary retention cannot be explained by separation bladder, if it was performed during the operation, since urinary retention is noted without this factor. Quite often, due to urinary retention, it is not uncommon to be afraid of pain during straining when urinating. As mentioned above, it is recommended to train patients to urinate while lying down before surgery, which is very useful.

For the treatment of already developed urinary retention, you need to start with simple measures; a heating pad on the bladder area, warm microclysters, sitting. The vessel must be served warm so that there is no reflex spasm of the sphincter from contact with a cold object; for this purpose, little hot water is poured into the vessel.

Of the drugs, 20 ml of a warm solution of 1-2% collargol or 20 ml of 2% are used in the bladder boric acid with the addition of one third of glycerin. It is possible to prescribe intravenous administration of 5-10 ml of 40% urotropine, which often gives a positive result. From time to time, subcutaneous administration of 3-5 ml of 25% magnesium sulfate acts favorably. Finally, as with intestinal paresis, a good remedy against urinary retention is the introduction of repeated small doses (0.5 ml) of pituitrin under the skin.

If the drugs do not work, then they resort to catheterization. For the prevention of cystitis, catheterization must be carried out strictly aseptically.

In the postoperative period, pyelitis develops in those operated by the ascending method from the bladder and by the lymphatic method from the intestines, especially with constipation. Bact is seen as the causative agent in 90% of cases. coli; along with this, right-sided pyelitis is more often observed due to the transition of infection through the lymphatic vessels from the hepatic curvature or another part of the colon to the pelvis of the right kidney.

Therapy is contained in the appointment of a dairy-plant diet, alkaline waters, heating pads for the lower back; advise lying on the left side (with right-sided pyelitis); antibiotics and sulfodimezine are used from medicinal substances.

The postoperative anuria that develops in rare cases (in people with kidney failure, at the end of a long anesthesia in severely exsanguinated people) is in most cases a severe complication and quickly leads to uremia and a lethal outcome.

Small suppuration of the abdominal wound at the end of the laparotomy is treated, as in surgery, by removing the stitches and pushing the edges of the wound apart to the width necessary for the free outflow of pus. A good way to treat festering operating wounds is to irradiate them with a quartz lamp with a gradual increase in the dosage of ultraviolet rays.

If the suppuration is not eliminated after a couple of days and there is a festering fistula, then this indicates an infection in the area of \u200b\u200ba non-absorbable silk ligature (ligature fistula). In these circumstances, it is necessary to remove the ligature under local anesthesia, after which the fistula quickly closes.

When treating a wound, it is better not to resort to packing. With wide suppurations, but not affecting the aponeurosis, the wound is opened, extensively and loosely tamponed. At the time when the wound is cleaned and the granulation culture is sterile, it is possible to apply a secondary suture. This applies not only to wounds at the end of the laparotomy, but also to perineal wounds that have come apart due to the suppuration.

With deep suppuration of the subcutaneous tissue with a divergence of the aponeurosis (at the end of the laparotomy), the uterus and intestinal loops can enter the wound. Treatment is a secondary suture.

Stump infiltrates when using catgut instead of not well absorbable silk are relatively rare at the end of gynecological operations. If infiltrates develop, then there is a danger of infection transfer to the parametrium and peritoneum.

Complete dehiscence of the wound of the abdominal wall with the release of the viscera - eventration - is a very rare complication. In 80% of cases, cachexia, intoxication, severe anemia, severe metabolic disorders (vitamin deficiencies, diabetes) are not uncommon due to this severe complication. The pretext for the onset of eventration is coughing, straining. intestinal atony. Eventration occurs in most cases between the 6th and 12th day after the end of the operation, much more often on the eighth day when the stitches are removed. The type of anesthesia and suture material are irrelevant in the origin of the eventration.

Almost all obstetricians-gynecologists apply a blind suture when the event occurs, capturing the skin, tissue and aponeurosis; it is more optimal to use knotted, not narrow silk ligatures. In case of peritoneal phenomena or local suppuration, it is directed to inject penicillin into the wound. Under no circumstances is it necessary to refresh the edges of the wound during eventration and separate the intestinal loops soldered to the parietal peritoneum.

Sleep therapy is recommended to combat postoperative complications. According to the observations of E. M. Kaplun, during sleep therapy, the need for catheterization decreased tenfold; the need for an enema, a gas outlet tube, as a means of combating flatulence, has been reduced by 2.5-3 times; the strength of the patients was restored much faster,

Thromboembolic disease. According to V.P. Mikhailov and A.A. Terekhova, in the pathogenesis of thromboembolic disease, a huge role is played by physicochemical transformations of blood plasma colloids, causing a violation of its stabilization and an increase in coagulability. This disease is often seen in the postoperative period, especially in patients with enlargement of the saphenous veins, a history of thrombophlebitis, with an increase in blood prothrombin, obesity, etc. therapy of thromboembolic disease. Use anticoagulants to be directed under the control of determining the level of prothrombin in the blood; its level should be at least 30% when using pelentan or at least 50% when treating with dicumarin (Mikhailov and Terekhova). For the success of prevention and treatment with anticoagulants, early recognition of the clinical manifestations of thromboembolism is essential. Many cases of pneumonia and pleurisy in the postoperative period should be attributed to embolic processes in the lungs such as a heart attack. Prevention through anticoagulants should be combined with early active movements in bed; active behavior and discharge of patients can be allowed only when ROE is below 20 mm and blood viscosity is not higher than 5.

Physiotherapy exercises in the postoperative period. Of great importance for the prevention of postoperative complications is the use of rational physical education in operated patients.

According to M.V. Elkin, physiotherapy exercises in the postoperative period have the following tasks: to restore normal breathing, reduce the work of the heart, prevent intestinal paresis, postoperative acidosis, ischuria, and adhesions and adhesions due to improved blood circulation in the operation area.

The exercise therapy schemes proposed by different authors for the operated patients should be considered only approximate, since in practice these or those exercises are prescribed strictly personally, depending on the patient's condition and the goals that exercise therapy pursues in this case; the attending doctor must give appropriate instructions to the exercise therapy methodologist who conducts classes with patients.

In most cases, in the first few days after the end of the operation, the exercises should be simple (breathing, raising the arms, squeezing and unclenching the fingers with flexion and extension of the feet, etc.); it is not yet permitted to strain the abdominal muscles. In the following days (before getting up for 5-7 days), the exercises become more difficult. At the end of the permission to rise, the patient performs the exercises while sitting on a chair.

Complexes for therapeutic exercises for postoperative gynecological patients are given in different departments, as well as in Gynecology prof. M. S. Malinovsky. We prescribe the same exercises, choosing together with the methodologist personally for each patient or for two or four patients 3-8 required exercises.