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

The gallbladder is involved in the process of digesting food. A pear-shaped organ located under the liver. The main functions are the accumulation (deposit) and excretion of fluid secreted by the liver. Bile helps to absorb fats in the body and activates the work of the stomach.

Cholecystectomy is surgical. The whole organ is excised by surgical intervention. Without it, people lead a normal life, following 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 body, it causes a lot of inconvenience: it worsens the state of health, the state of health. Symptoms appear:

• Stomach ache;
• stool disorder;
• Nausea and vomiting;
• Increase in body temperature, etc.

• Gallstone disease (GSD). 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 cholelithiasis.
• Education .

With these diagnoses, the patient needs surgical medical intervention. Modern medicine, when removing an organ, performs cholecystectomy by 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 undesirable 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. After anesthesia, dizziness and fainting are possible. The recovery period lasts 7 days. After 10 days, in a satisfactory condition, the patient is discharged.

A person whose gallbladder has been cut out should follow the advice:

• Do not break the dietary table, observe the diet. Healthy food, a balanced diet menu is an important part in the recovery process of the body. Diet after you need to follow for life. Target diet food- stimulate the excretion of bile from the body, stabilize the metabolism. If the patient did not adhere to the recommendations of the doctor on nutrition, attacks of cholecystitis are possible.
• Application medicines. 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.
• Doing exercises. Massage gymnastics for the abdomen (two months). The first time to do the exercises should be 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 well-being faster and normalize the functioning of the digestive tract. Failure to comply with the instructions of the attending physician will adversely affect health.

Diet after surgery

Nutrition after cholecystectomy is aimed at restoring metabolic processes in the body, food should be healthy, sparing 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 (allowed and prohibited) after cholecystectomy

Despite the restrictions, the food of a person with a removed gallbladder remains balanced. The body needs constant replenishment of nutrients, useful microelements. Proper nutrition- the key to a quick recovery. After the operation, there is a lack of appetite. It is important to tell 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 not allowed. They provoke an increased secretion of bile.

Prohibited Products

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

If you exclude the listed foods, you can avoid unpleasant consequences and complications. A year later, some foods from the list of prohibited foods can be introduced into the diet, a diet scheduled by day is used. Nutrition is 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 allowed foods, you can make meals healthy, tasty, varied. Make a menu for the week. Use different ways cooking. A strict diet will help to cope with the pathologies of the gastrointestinal tract, with excess weight, improve health. Remember! Portions should be small (200 g), meals should be fractional (6 times a day), the amount of water drunk should not exceed 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. Make 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 tea. Kissel with crackers, bananas.
• Dinner. Prepare minced fish cutlets in a steam bath. Cottage cheese casserole, compote.
• Second dinner. At night, you can drink a glass of yogurt.

Option 2:

• Breakfast. Prepare a protein omelet (separate the yolk). Make a rosehip decoction.
• Lunch. Apricots are good for snacking.
• Dinner. Diet vegetable soup cauliflower, carrots, bell pepper, salt). For the second, prepare the cod liver. Oat cookies for dessert, warmed milk.
• afternoon tea. Yesterday's bread (crackers), cheese, compote.
• Dinner. Cooking pasta with gravy. Tea with milk. For dessert, dates, raisins or marshmallows.
• Second dinner. Portion of low-fat cottage cheese.

Option 3:

• Breakfast. Millet porridge, juice.
• Lunch. Diet yogurt.
• Dinner. Soup (champignons, potatoes, greens). Unsweetened cookies, compote.
• afternoon tea. Steamed zucchini, mint tea.
• Dinner. Boil shrimp, make mashed potatoes. Fruit jelly and tea for dessert.
• Second dinner. A glass of fermented baked milk and crackers.

Option 4:

• Breakfast. Buckwheat porridge, herbal tea and souffle (you can add raspberries, the berry activates the digestion process).
• Lunch. Dairy products (kefir, curdled milk).
• Dinner. Cook the fish in a steam bath, make a salad. Drink a glass of juice.
• afternoon tea. Boiled corn, compote.
• Dinner. It is allowed to cook pizza using permitted products for the filling. As a dessert, tea with marshmallow.
• Second dinner. Light salads are fine.

Option 5:

• Breakfast. Diet cottage cheese (can be chopped in a blender, add a little dried apricots), green tea.
• Lunch. Banana.
• Dinner. Mashed potatoes with fish cutlets. Zephyr, tea.
• afternoon tea. Sandwich, rosehip decoction.
• Dinner. Seafood soup. Jelly tea.
• Second dinner. Dried apricots, raisins.

Not recommended for the first time tomato juice. It is supposed to eat, strictly following 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 healthy lifestyle life.

When a person successfully undergoes surgical treatment, he begins the recovery period. Many immediately have questions: what can I eat after the operation? How soon after the operation can I eat? In most cases, during this period, the patient is prescribed a specific diet that provides answers to these questions. The strict adherence to such a diet is an extremely important factor for a successful rehabilitation process.

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

Depending on the type of surgery, diets vary in nature. Below is a description of the key cases and their respective diets.

Operation types

The key types of operations for which a diet can be prescribed are divided according to the actions taken:

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

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

The main task: to saturate the body with essential nutrients and reduce the load on the body, both in general and on the cavity for which the operation was performed.

Nutrition 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 eating: eat small portions, up to seven times a day.

This diet is the main diet 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.

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

The 0V 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, cereals with milk (liquid type), grated cottage cheese (with cream), kefir, baked apple products and white crackers. Calorie indicator per day - no more than 2200 kcal.

What products are contraindicated? These include the following:

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

Goal: limit the consumption of junk food.

Term: up to three months.

• lean meats and fish;
• weak meat and vegetable broths;
• dried bread;
• dairy products (low-fat type).

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

This diet after surgery involves a fractional principle of eating. Patients eating 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. Calorie indicator per day - no more than 2500 kcal.

The following products are prohibited:

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

Purpose: to exclude coarse vegetable fiber and indigestible foods from the human diet. This postoperative diet allows you to reduce the contraction of the digestive tract and reduce flatulence in the body.

Deadline: up to one month.

What to eat after this type of surgery?

The composition of the diet will be as follows:

• grated cereals (for example, buckwheat);
• broth from boiled vegetables;
• light egg dishes;
• kissels and jelly (from apples, pears, quince);
• soft drinks (non-alcoholic);
• coffee without milk.

The principle of eating: eat in small fractional portions.

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

Foods that should not be consumed:

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

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

Deadline: up to 14 days.

What to eat after this type of operation?

The composition of the diet will be as follows:

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

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

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

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

The purpose of the diet: a sparing regime for the body, relieving stress and gradually getting used to food that is difficult to digest.

Diet term: up to one month.

The composition of the diet:

• 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 eating: 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 products include the following:

1. spicy, salty and fried foods;
2. acidic 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.

The composition of the diet:

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

The principle of eating: food after surgery is taken in small portions, up to seven times a day.

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

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

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

In this article, some of the most frequent operations and short description appropriate diets for them. Following this description will accelerate the positive rehabilitation of the body during the recovery period.

Operations related to the gastrointestinal tract are familiar to many. Within the limits of 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 entails consequences. This is especially true for organs. abdominal cavity. Adhesions form in the intestines, which indicate obstruction.

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

1. For two days after the operation, the patient is prescribed fasting. However nutrients enter the body with the introduction of solutions intravenously.
2. For 14 days, a person should consume sparing, liquid food.
3. Further eating involves steaming or boiling dishes, after which it is recommended to grind the cooked foods into porridge.
4. It is recommended to follow a diet after surgery for 30 days.
5. During this period, it is forbidden to eat junk food, more protein of animal origin should be included in the diet.
6. Eating should take place strictly at the same time.
7. Fractional nutrition. 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 must be warm.
9. It is recommended to include dairy products in the diet.

What products are prohibited for consumption?

The correct diet after surgery on the gastrointestinal tract includes the rejection of harmful products, which include:

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

The dietary diet for patients prohibits the use of fried, salted, peppered, smoked foods. Also, you can not use various sauces and spices for cooking and seasoning dishes.

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

The essence of the diet is to regulate the patient's stool, peristalsis and relieve pain in the intestines. A properly composed diet does not burden the gastrointestinal tract, which is why tissue repair proceeds faster. The recovery period is shorter.

Foods allowed after surgery

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

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

Patient's menu after surgery for intestinal obstruction

The cause of intestinal obstruction is organic lesions of a tumor nature. Because of this, it is recommended to approach the diet with caution.

Doctors determine the causes of the disease and methods for their elimination. For quality treatment, it is recommended to strictly adhere to the diet.

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

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

Note! Products should be served warm immediately after cooking.

The postoperative diet provides for the following mandatory requirements:

• do not heat food in the microwave;
• complete rejection of preservatives;
• it is forbidden to use products containing artificial flavors and dyes;
• it is recommended to refuse salt completely, in extreme cases, reduce its consumption to a minimum.

Within 12 hours after the surgeon performed the operation, you can not eat or drink. Consuming useful and nutritious substances is required in the form of intravenous solutions.

This diet has a beneficial effect on the human intestines. All food that enters the body must be freely absorbed. Portions should be reduced and divided into 5 or 6 doses per day.

In addition to the mandatory food, the patient should consume 2 liters of water per day, and the food must be rubbed or turned into gruel.

Video - Proper nutrition after removal of an intestinal tumor

Diet after bowel 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 draws up a menu for the patient, based on the testimony. A mandatory requirement in the diet is the presence of fruits and vegetables. And it is recommended to exclude junk food. The method of preparation of products is the same as with any diet after abdominal surgery.

Any surgical intervention in the human intestine impairs the absorption of beneficial components. To normalize this process, you should take a light meal that does not irritate the digestive tract.

The obligatory 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 per day. Portions should be reduced.

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

Approximate diet for a week

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

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

One of the options for a weekly home diet after bowel surgery:

Day	diet	Image
First	for lunch - light soup and compote; for dinner - compote and fish soufflé; before going to bed mug of kefir
Second	From 7 to 8 in the morning - rice porridge on the water and green tea; from 10.00 to 11.00 of the day - fruit; for lunch - a light vegetable soup, crackers and compote; 16.00 to 17.00 - fruit drink and berries; for dinner - cottage cheese casserole with honey and tea; before going to bed - a decoction of wild rose
Third	From 7 to 8 in the morning - buckwheat porridge on the water and green tea; from 10.00 to 11.00 - fruit; for lunch - light fish soup and compote; 16.00 – 17.00 - boiled egg and crackers; for dinner - mashed potatoes with minced meat; before going to bed - 250 ml of natural yogurt
Fourth	From 7 to 8 in the morning - oatmeal on 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 mug of kefir
Fifth	From 7 to 8 in the morning - barley porridge and black tea; from 10.00 to 11.00 days - boiled egg; for lunch - chicken soup and compote; 16.00 –17.00 - fruit; · 18.00 –19.00 - kissel and meat soufflé; before going to bed mug of kefir
Sixth	From 7 to 8 in the morning - egg white omelet, crackers and tea; from 10.00 to 11.00 days - berries; for lunch - light rice soup and compote; 16.00 - 17.00 - fruit and a glass of tea; for dinner - mashed potatoes, steamed meatballs and jelly; rosehip decoction before bed
Seventh	From 7 to 8 in the morning - rice porridge on the water and compote; from 10.00 to 11.00 days - boiled egg and crackers; for lunch - light soup with vegetables and compote; 16.00–17.00 - cottage cheese with 0% fat content 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 provides for a certain diet. However, there are a few tips for compiling it at home:

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

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

A properly composed diet for the rehabilitation period will reduce the load on the gastrointestinal tract and speed up the recovery process. It is especially important to stick to the diet after discharge from the hospital.

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

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

Importance and goals of diet

After gastrectomy during the rehabilitation period, it is important to eat right so that further recovery takes place without complications. The postoperative diet is aimed at quickly healing the rest of the stomach, because during this period, the usual food can worsen the condition. sample menu, permitted products and cooking recipes 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 pursued by the diet after removal of the stomach is not to bring the patient to exhaustion and maintain his weight within the normal range.

After resection of the stomach for cancer or any other severe pathology, the anatomy of the digestive organ changes, and the conditions under which food will be digested normally also change accordingly. Restorative nutrition after removal of part of the organ allows the body to gradually adapt to new conditions, so that the risk of dangerous complications is minimized.

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 odds of the pathology, it is forbidden to take any food. Sometimes restrictions are imposed on water, but here the doctor decides everything. When the risk of early postoperative complications passes and in the absence of contraindications, you can start taking liquid in the form of vegetable broth, jelly. Then food, kefir, curd soufflé, ground to a puree state, is added to the diet.

A week later, new dishes are added. It is recommended that a person be fed mashed potatoes, boiled or steamed. meat dishes, half grated vegetable soups. Freshly squeezed juices, some crackers or dryers, dried bread are also allowed. When the stomach is removed, food is prepared in a gentle way, without the use of salt, spices and seasonings.

After 3 months, nutrition after gastric surgery expands. You can eat half-ground 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 food of different composition.

Further diet

Despite some dietary restrictions, after the operation, patients will not starve, because the dietary table contains a lot of tasty and wholesome food, however, the method of its preparation is different from the usual. 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 fried food to cooked food is strictly prohibited.

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

What can you eat?

Boiled eggs must be included in your diet.

The diet after gastric resection for oncology or ulcerative lesions will be strict, but the list of allowed foods is not scarce, so the person will not starve. The menu must include the following foods:

• Eggs boiled or in the form of a steam omelet;
• Lean meat - 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 cereals 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 boiled only on water, if desired, a little milk and butter can be added to the finished dish. As drinks, it is recommended to use green tea with milk, dried fruit compotes, herbal decoctions 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 these lasts about three or 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 (sometimes, except for uterine contractions), 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 adhesive tape.

At the end of the operation, the patient is placed in the postoperative ward under the supervision of an on-duty or intentionally dedicated nurse.

Postoperative wards should have one to three beds and be located near the operating room and the duty post. Only after the completion of minor gynecological operations, it is possible for patients to be placed in wards with four to six beds, which are intended, but, in addition, for those who have undergone an operation relatively recently.

The operated patient is placed on a pre-prepared and warmed bed. If necessary, the patient is heated with heating pads, cardiac, glucose, physiological saline, etc. are administered. An ice pack is placed on the belly at the end of the abdominal surgery to reduce pain in the wound and to prevent hematoma. In case of vomiting at the end of anesthesia, a basin, a mouth expander, 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. For obese people, it is useful to wrap the belly over the bandage with a special towel with ties in front (gurita).

In the postoperative wards, you need to have oxygen at the 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 operation.

Already after 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 ones: flatulence, urinary retention, etc. The negative effect of postoperative pain on the central nervous system has been proven; some surgeons see in them the cause of the development of shock and postoperative psychosis.

With the early onset of pain, promedol 2% 1-2 ml subcutaneously is prescribed, 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 inside 0.025 1 pill 3 times a day the next day after 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. narcotic substance. It is recommended not to prescribe anything internally; on the epigastric region - heating pads. When 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 does not have the opportunity to urinate herself (into a heated vessel), then urine is produced by a catheter in compliance with all asepsis rules. With urinary retention 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 has undergone surgery under non-specialized anesthesia, after 3-4 hours (not earlier than 1-2 hours, after the end of vomiting), they are allowed to drink warm strong tea with lemon. At the end of a large blood loss, it is necessary to re-give a lot of fluid: it should be emphasized that in these patients vomiting is less common after the end of anesthesia, so they need to start allowing them to drink earlier. It is extremely important almost immediately after waking up from anesthesia to force the operated woman to breathe deeply to remove the remnants of ether from the lungs ( breathing exercises).

Those who have undergone surgery under spinal or local anesthesia may be allowed to drink after 15-20 minutes. at the end of the operation; it quenches thirst, regulates water metabolism 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 regimen 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 add porridge (rice, semolina), crackers, rolls, butter; from time to time, to stimulate the appetite of not strong patients from the fourth or fifth day, it is useful to prescribe protein substances in a small amount - caviar, ham. At the end of a single or double action of the intestines, patients are transferred to a non-specialized table.

From the very beginning of the operation, it is necessary to monitor the cleanliness of the mouth and tongue (rinsing with a weak solution of potassium permanganate, cleaning the tongue mechanically - with gauze wrapped on a spatula).

Gut 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, prescribe a cleansing enema of 1 liter of water (with soap) or give a saline laxative.

At the end of vaginal operations with suturing of 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 brackets are removed for a week, silk sutures - for the eighth. Seams at the crotch at the end plastic surgery removed early - for five days, since later removal of the sutures can cause their eruption.

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 partly explained by the shorter duration of obstetric operations and anesthesia during them. In gynecological practice, shock may appear at the end of huge long operations (for example, at the end of an extended extirpation of the uterus for cervical cancer). Collapse (lesion of 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 most cases consciousness is preserved in shock, while in collapse it is clouded; in case of shock, the color of the integument is pale yellow, matte; in case of collapse and blood loss, the skin integuments are pale to marble-shiny whiteness.

In case of shock and collapse, patients are laid down with their heads down, covered with heating pads; cardiac agents are injected under the skin or into a vein - camphor (subcutaneously), caffeine, strophanthin, strychnine. Adrenaline is especially advised 1. 1000-0.5 ml intramuscularly or into a vein; in view of the brevity of the action of adrenaline, it is necessary to re-introduce it in 0.1-0.2 ml. Instead of adrenaline, it is possible to use pituitrin subcutaneously. It tones the blood vessels and has a longer effect than adrenaline. To stimulate the vasomotor center, it is recommended to inhale carbon dioxide, preferably 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 with adrenaline is administered (by intravenous drip) or some kind of anti-shock liquid. With severe blood loss and shock a good remedy there is a blood transfusion (after the restoration of proper blood circulation) in large quantities (up to 1 liter), preferably in two doses.

Secondary bleeding in the trunk can be observed at the end of laparotomy, less often at the end of vaginal removal of the uterus, much more often when the ligature slips from the vascular stump; they present with symptoms of internal bleeding. The only true therapy in these circumstances is urgent relaparotomy and ligation of bleeding vessels.

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

Vomiting in the postoperative period is not uncommon of various origins, and therefore 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 that appears later may be an indicator of acute dilatation of the stomach, incipient peritonitis, or intestinal obstruction. the best way the treatment of vomiting is rest for the stomach; no food or drugs should 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 lavage according to Bukatko is prescribed. When 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-excretion of gases, it is possible to first apply gastric lavage, inject hypertonic NaCl solution (10% 50-100 ml) into a vein, and prescribe siphon enemas. With vomiting, depending on the onset of peritonitis, the stomach is washed, penicillin is administered (intramuscularly at 150,000 IU every three hours). In the event that there is no result, in both cases, they immediately proceed to (repeated) abdominal dissection.

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

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

A simple remedy against flatulence is the introduction of a tube into the rectum (12-15 cm), which immediately eliminates one of the causes of flatulence - spasm of the sphincter. It is excellent to combine the introduction of a tube with thermal procedures, for example, an electric light bath (recommended by Gelinsky). But vigorous heat is perhaps contraindicated in a tendency to uterine bleeding. To stimulate intestinal peristalsis, many surgeons and gynecologists use physostigmine subcutaneously in 0.5-1 ml of a 0.1% solution. It is possible to administer it prophylactically even on the operating table, and a glycerin enema can be prescribed days after the end of the operation.

More often, physostigmine is prescribed under the skin once or twice a day in combination with a vent tube and a dry-air bath. If this drug is not at hand, it is successfully possible to replace it with pituitrin. The effect of pituitrin, besides stimulating the peristalsis of the intestines, is very useful in other respects: it raises blood pressure, promotes urination, which is usually not uncommon. Pituitrin is injected 0.5-1 ml twice a day under the skin.

As for enemas, they can be advised at the end of the days after the operation in the form of microclysters from a hypertonic saline solution (10% 100 ml) or much better in the form of glycerin enemas (one to two tablespoons of glycerin in 1/2 cup of water). The enemas of pure, undiluted glycerin recommended by some are very irritating to the rectal mucosa. In the event that hypertonic, glycerin or simple enemas do not have an effect, they switch to siphon enemas by introducing a rubber tube above the internal sphincter; siphon enemas from hypertonic (10%) saline solution 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 performed 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, abstinence from inhalation anesthesia in favor of local or spinal anesthesia, no doubt, reduces the frequency and severity of postoperative complications in the lungs.

Prevention of inflammation of the lungs and bronchitis is contained in the protection of patients from cooling, for example, during sanitation. Patients with bronchitis, emphysema, pulmonary tuberculosis are best operated not under ether anesthesia, but under local anesthesia or thiopental-sodium intravenous drip anesthesia. To reduce mucus secretion from 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 cans on the chest, heart remedies under the skin, a high position of the upper body (in the absence of contraindications - anemia - and only four to six hours after the end of the operation) . From the very beginning, the operated patients should be directed to turn from one side to the other and not to let them lie on their backs for a long time.

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

Urinary retention can be observed both at the end of 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 even without this factor. Quite often, the cause of urinary retention is not uncommon, the horror of pain during straining when urinating. As mentioned above, it is recommended to accustom patients before surgery to urinate lying down, which is very useful.

To treat an already developed urinary retention, you need to start with simple measures; heating pad on the bladder area, warm microclysters, planting. 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 used is the introduction into the bladder of 20 ml of a warm solution of 1-2% collargol or 20 ml of 2% boric acid with the addition of one third of glycerin. It is possible to prescribe intravenous administration of 5-10 ml of 40% urotropin, which quite often gives a positive result. From time to time, subcutaneous administration of 3-5 ml of 25% magnesium sulfate works favorably. Finally, as in paresis of the intestines, a good remedy for urinary retention is the introduction under the skin of repeated small doses (0.5 ml) of pituitrin.

If medicines do not have an effect, then they resort to catheterization. For the prevention of cystitis, catheterization should be carried out strictly aseptically.

In the postoperative period, pyelitis develops in those operated on by the ascending method from the bladder and by the lymphatic method from the intestines, especially with constipation. As a pathogen in 90% of cases, bact is seen. coli; along with this, right-sided pyelitis is more often observed due to the transfer 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 milk-vegetarian diet, alkaline waters, heating pads for the lower back; advise lying on the left side (with right-sided pyelitis); from medicinal substances antibiotics are used, and sulfodimesin.

Postoperative anuria that develops in rare cases (in persons with kidney failure, after a long anesthesia in sharply bled patients) is in most cases a severe complication and leads quickly to uremia and death.

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

If 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\u200bnon-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 tamponing. With wide suppurations, but not affecting the aponeurosis, the wound is opened, extensively and loosely tamponed. At a time when the wound is clean and the seeding from the granulation is sterile, it is possible to apply a secondary suture. This applies not only to wounds at the end of laparotomy, but also to perineal wounds that have expanded due to 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 the imposition of a secondary suture.

Infiltrates of the stumps when using catgut instead of not well-absorbed silk are observed at the end of gynecological operations relatively rarely. If infiltrates develop, then there is a danger of infection moving to the parametrium and peritoneum.

Complete divergence of the wound of the abdominal wall with the exit of the viscera - eventration - is a very rare complication. In 80% of cases, the cause of this severe complication is not uncommon cachexia, intoxication, severe anemia, severe metabolic disorders (avitaminosis, diabetes). 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 sutures are removed. The type of anesthesia and the material for the sutures do not matter in the origin of the eventration.

Almost all obstetrician-gynecologists impose a deaf suture when the eventration has taken place, capturing the skin, fiber and aponeurosis; it is better to use nodal, not narrow silk ligatures. In case of peritoneal phenomena or local suppuration, penicillin should be injected into the wound. Under no circumstances is it necessary during eventration to refresh the edges of the wound and to separate the intestinal loops soldered to the parietal peritoneum.

To combat postoperative complications, sleep therapy is advised. According to the observations of E. M. Kaplun, during sleep therapy, the need for catheterization decreased tenfold; the need for an enema, gas tube, as a means of combating flatulence, decreased by 2.5-3 times; the strength of the patients recovered much faster,

thromboembolic disease. According to V.P. Mikhailov and A.A. Terekhova, physicochemical transformations of blood plasma colloids play an important role in the pathogenesis of thromboembolic disease, causing a violation of its stabilization and an increase in coagulability. This disease is often seen in the postoperative period, especially in patients with saphenous vein dilation, a history of thrombophlebitis, with an increase in blood prothrombin, obesity, etc. The current use of fibrinolytics and anticoagulants (heparin, dicoumarin, neodicumarin, pelentan) is likely to prevent and therapy for 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 treated with dicoumarin (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 infarction. Prevention by means of anticoagulants should be combined with early active movements in bed; active behavior and discharge of patients can only be allowed if the ESR is below 20 mm and if the blood viscosity is not higher than 5.

Therapeutic exercise 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 surgical area.

The exercise therapy schemes proposed by different authors for the operated patients should be considered only exemplary, since in practice certain exercises are prescribed strictly personally, depending on the patient's condition and the goals pursued by exercise therapy in this case; the attending physician should give appropriate instructions to the exercise therapy methodologist who conducts classes with patients.

In most cases, in the first few days after the operation, the exercises should be simple (breathing, raising the arms, squeezing and unclenching the fingers with flexion and extension of the feet, etc.); tensing the abdominal muscles is not yet allowed. 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 conducts exercises while sitting on a chair.

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