home Analyzes Possible complications during the operation. Complications and postoperative mortality Menopause after hysterectomy

Possible complications during the operation. Complications and postoperative mortality Menopause after hysterectomy

After BPH surgery, patients usually experience significant improvement in BPH symptoms

Where, TURP – transurethral resection of prostate adenoma
TUIP – transurethral incision of prostate adenoma

But, like any treatment, surgery can cause complications after surgery for prostate adenoma. Some complications arise in the early postoperative period. Also, a number of complications after surgery for prostate adenoma arise after several months or even years.

Early complications after surgery for prostate adenoma
			Adenomectomy
Infection
Bleeding requiring treatment
Impotence
Retrograde ejaculation
Urinary incontinence
Late complications after surgery for prostate adenoma
Strictures of the urethra and bladder neck
Need for repeat surgery after 5 years

Infection of the genitourinary system – a complication after surgery for prostate adenoma, the risk of which can be minimized through proper preoperative preparation and adequate antibiotic therapy after surgery. Before surgery, your doctor will order a general urine test to rule out urinary tract infections. If you have symptoms of a genitourinary tract infection or a urine test reveals inflammatory cells and bacteria, your doctor will prescribe you a course of antibiotics before surgery. After surgery, you will also need to take antimicrobial medications for several days. If you follow all the recommendations, you will reduce the risk of an infectious complication after surgery for prostate adenoma.

For the first few days after surgery, you may experience hematuria—blood in your urine. As a rule, this phenomenon does not require medical intervention and resolves on its own. A few weeks after transurethral surgery, the scab (crust) formed in the resection area may be rejected, resulting in blood appearing in the urine. As a rule, such a complication after surgery for prostate adenoma is relieved by maintaining bed rest and drinking plenty of fluids. In rare cases, bleeding that occurs requires medical intervention. Excessive bleeding may occur in people with bleeding disorders or in patients taking anticoagulant drugs. Stopping these medications 7 days before surgery reduces the risk of bleeding after surgery. If you see that your urine is a deep red color or there are blood clots in it, be sure to contact your doctor.

All men are interested in the question “Will surgery affect their sex life?” Some sources provide information that operations for adenoma extremely rarely cause complications in the sexual sphere, while other researchers claim that problems with sexual activity occur in 20% of cases.

Erection

The likelihood that surgical treatment of prostate adenoma will affect the ability to achieve an erection is extremely small. If before the operation you had problems achieving an erection, then the treatment will not be able to affect the restoration of potency. But if before surgery you did not have problems with erection, then after surgery there will be no problems with sexual activity.

Despite the fact that surgical treatment does not affect the ability to achieve an erection, many men develop a complication after surgery for prostate adenoma, such as retrograde ejaculation. This condition is also called “dry orgasm”. During the operation, hyperplastic prostate tissue is removed, and the prostatic part of the urethra and bladder neck are expanded. Therefore, during ejaculation, sperm does not move into the urethra, but takes the path of least resistance into the bladder. When urinating, damaged sperm are excreted in the urine. Retrograde ejaculation causes infertility in men. In some cases, this complication can be treated with a medicine called pseudoephedrine. Pseudoephedrine improves muscle tone at the bladder neck, which prevents sperm from entering the bladder.

Orgasm

Most men claim that after surgery there are no changes in the sensations that occur during orgasm. Although it will take you some time to get used to retrograde ejaculation, your sex life will be just as enjoyable as before the surgery.

Urinary incontinence

A complication after surgery for prostate adenoma, such as urinary incontinence, can bother a man for the first time after treatment. It is important to understand that it takes some time to restore normal bladder function, and the longer a man has suffered from prostate adenoma, the longer it takes to regain urinary control.

Is re-treatment required after surgery for prostate adenoma?

During a transurethral adenomectomy, open or laparoscopic surgery, the doctor removes the entire prostate, so benign prostatic hyperplasia does not develop again after this operation. In other operations, part of the hyperplastic prostate tissue is removed, so there is a possibility of re-development of benign prostatic hyperplasia. After operations for prostate adenoma, as a rule, there is no need for re-treatment for more than 15 years.

Only 10% of men require revision surgery for prostate adenoma.

As for minimally invasive methods of treating prostate adenoma, such as microwave thermotherapy, transurethral needle ablation, etc., it can be noted that the risk of complications is lower than after surgery, but much more often there is a need for re-treatment in the first 3-5 years after the procedure.

After major operations, a serious condition usually develops as a response to severe, long-term injury. This reaction is considered natural and adequate. However, in the presence of excessive irritation and the addition of additional pathogenetic factors, unforeseen conditions may arise that aggravate the postoperative period (for example, bleeding, infection, insufficient sutures, vascular thrombosis, etc.). Prevention of complications in the postoperative period is associated with rational preoperative preparation of the patient (see Preoperative period), the correct choice of anesthesia and its full implementation, strict adherence to the rules of asepsis and antisepsis, the surgeon’s careful handling of tissues during surgery, the choice of the desired surgical method, and good technique. implementation and timely implementation of medical measures to eliminate various deviations in the normal course of the postoperative period.

Some time after a major operation, under the influence of pain impulses emanating from an extensive surgical wound, shock and collapse may develop, which is facilitated by blood loss. After a period of anxiety, the skin becomes pale, cyanosis of the lips occurs, blood pressure drops, the pulse becomes small and frequent (140-160 beats per minute). In the prevention of postoperative shock, the removal of painful stimuli is important. After extensive traumatic interventions, which inevitably cause prolonged and intense pain, they resort to the systematic administration of drugs not only at night, but several (2-3, even 5) times a day during the first two and sometimes three days. Subsequently, the pain decreases, which allows you to limit drug use (only at night, 1-2 days). If repeated use is necessary, it is better to use promedol rather than morphine. Some authors recommend using superficial anesthesia with nitrous oxide in the postoperative period to relieve pain. At the same time, measures to replenish blood loss and the prescription of antihistamines (diphenhydramine) are necessary.

If postoperative shock develops, the patient is warmed in bed, the foot end of the bed is raised and complex anti-shock therapy is carried out (see Shock). After the shock phenomena are relieved, further measures are carried out according to individual indications.

Bleeding in the postoperative period may occur due to the slipping of ligatures from the gastric arteries, the stump of the auricle of the heart, the stump of the vessels of the lung root, the arteries of the limb stump, from the intercostal, internal thoracic, inferior epigastric and other arteries. Bleeding can also begin from small vessels that did not bleed during surgery due to a drop in blood pressure and therefore remained unligated. At a later date, massive bleeding can occur due to arrosion of the vessel during the development of a purulent process (the so-called late secondary bleeding). Characteristic signs of acute bleeding are: severe pallor, rapid small pulse, low blood pressure, patient anxiety, weakness, profuse sweating, bloody vomiting, blood soaking the bandage; In case of intra-abdominal bleeding, dullness is determined by percussion in sloping areas of the abdomen.

Treatment is aimed at stopping bleeding while simultaneously receiving intravenous or intra-arterial blood transfusions. The source of bleeding is determined after opening the wound. Ligation of bleeding vessels is performed during relaparotomy, rethoracotomy, etc. In case of hematemesis after gastrectomy, conservative measures are initially taken: careful gastric lavage, local cold, gastric hypothermia. If they are unsuccessful, a repeat operation with revision and elimination of the source of bleeding is indicated.

Postoperative pneumonia occur more often after operations on the abdominal and thoracic organs. This is explained by the common innervation of these organs (vagus nerve) and the limitation of respiratory excursions that occurs after such operations, difficulty in coughing up sputum and poor ventilation of the lungs. Congestion in the pulmonary circulation, caused by insufficient respiratory excursions and, in addition, weakening of cardiac activity and the immobile position of the patient on his back, are also important.

Breathing disorders with subsequent development of pneumonia can also occur after major surgery in the cranial cavity. The source of pneumonia can be a postoperative pulmonary infarction. These pneumonias usually develop at the end of the first or beginning of the second week after surgery, characterized by severe chest pain and hemoptysis.

In the prevention of postoperative pneumonia, the administration of painkillers plays an important role; pain relief promotes deeper and more rhythmic breathing and makes coughing easier. However, morphine and other opiates should not be prescribed in large doses (especially when pneumonia has already begun) so as not to cause depression of the respiratory center. Cardiac medications are very important - injections of camphor, cordiamine, etc., as well as proper preparation of the patient's respiratory tract and lungs in the preoperative period. After the operation, the upper half of the body is raised in bed, the patient is turned more often, he is allowed to sit down and stand up earlier, and therapeutic exercises are prescribed. Bandages applied to the chest and abdomen should not restrict breathing. Oxygen therapy, cupping, cardiac medications, expectorants, sulfonamide and penicillin therapy are used as therapeutic measures for pneumonia.

At pulmonary edema there is sudden shortness of breath with bubbling breathing, sometimes with hemoptysis. The patient is cyanotic, with many different moist rales in the lungs. Treatment depends on the cause of the swelling. Cardiac medications, painkillers, bloodletting, oxygen therapy are used; fluid is aspirated from the tracheobronchial tree by intubation. If systematic, repeated aspiration is necessary, a tracheotomy is performed and the contents of the respiratory tract are periodically sucked out through a catheter inserted into the tracheotomy opening. The tracheotomy tube must always be patent; if necessary, change it or clean it well. Liquefaction of respiratory tract secretions is carried out using aerosols or rinsing. At the same time, oxygen therapy and other therapeutic measures are carried out. Patients are placed in separate rooms served by specially trained staff. In case of severe respiratory failure, they resort to controlled artificial respiration using a breathing apparatus.

Complications from the cardiovascular system. In the postoperative period, some patients develop relative heart failure, blood pressure drops to 100/60 mm Hg. Art., shortness of breath and cyanosis appear. The ECG shows increased heart rate and increased systolic readings. The decline of cardiac activity in a previously altered cardiovascular system is associated with stress caused by surgical trauma, anoxia, narcotic substances, and neuroreflex impulses from the area of intervention. Therapy consists of the use of cardiac drugs (camphor, caffeine, cordiamine), painkillers (omnopon, promedol), intravenous administration of 20-40 ml of a 40% glucose solution with 1 ml of ephedrine or corglycone.

In the first three days after surgery, especially after severe traumatic operations on the thoracic and abdominal organs, acute cardiovascular failure may occur. An effective measure in the fight against it is intra-arterial blood transfusion in fractional portions of 50-70-100 ml with norepinephrine (1 ml per 250 ml of blood). Favorable results are also obtained by injecting a 5% glucose solution with norepinephrine into a vein. Along with this, cardiac drugs are administered, the patient is warmed, and oxygen therapy is used.

Thrombosis and pulmonary embolism are serious complications of the postoperative period (see Pulmonary trunk). The occurrence of thrombosis is associated with disorders of the blood coagulation system, and the primary blood clots usually form in the deep veins of the leg. Long-term stasis, weakening of cardiac activity, age-related changes, as well as inflammatory processes predispose to the formation of blood clots. Prevention of thromboembolic complications consists of allowing the patient early movements after surgery and monitoring the state of the blood coagulation system, especially in elderly patients. In case of increased blood clotting (according to a coagulogram), anticoagulants are prescribed under the supervision of a systematic determination of the prothrombin index.

After abdominal surgery, it may occur abdominal wound dehiscence, accompanied by eventration (loss) of the viscera. This complication is observed between the 6th and 12th day after surgery, mainly in exhausted patients with flatulence or severe cough that developed in the postoperative period. In case of eventration, immediate surgery is necessary - repositioning the prolapsed organs and suturing the wound with thick silk. Interrupted sutures are passed through all layers of the abdominal wall (except the peritoneum) at a distance of at least 1.5-2 cm from the edges of the wound.

Complications from the gastrointestinal tract. When hiccups occur, the stomach is emptied with a thin probe, a 0.25% novocaine solution is given to drink, and atropine is injected under the skin. Persistent, painful hiccups may force the use of bilateral novocaine blockade of the phrenic nerve in the neck, which usually has a good effect. However, persistent hiccups may be the only sign of limited peritonitis with localization of effusion under the diaphragm. When regurgitation and vomiting, the cause of these phenomena is first identified. If peritonitis is present, it is necessary first of all to take measures to combat its source. Vomiting can be supported by stagnation of contents in the stomach and the presence of flatulence in the patient due to dynamic obstruction (postoperative paresis) of the intestine. Flatulence usually occurs by the end of the second day after surgery on the abdominal organs: patients complain of abdominal pain, a feeling of fullness, and difficulty in deep breathing. During the examination, abdominal bloating and a high diaphragm are noted. To remove gases from the intestines, suppositories with belladonna are prescribed; a gas outlet tube is inserted into the rectum for a while to a depth of 15-20 cm; if there is no effect, a hypertonic or siphon enema is given. The most effective means of combating postoperative dynamic obstruction of the gastrointestinal tract is long-term suction of the stomach contents (see Long-term suction).

A rare but serious complication in the postoperative period is acute dilatation of the stomach, which also requires constant drainage with a thin probe and at the same time restorative measures (see Stomach). Another serious disease, sometimes occurring in the postoperative period and occurring with the clinical picture of paralytic obstruction, is acute staphylococcal enteritis. In weakened, dehydrated patients, mumps may develop in the coming days after surgery (see). If mumps becomes purulent, an incision is made into the gland, taking into account the location of the branches of the facial nerve.

In patients with pathological changes in the liver in the postoperative period, liver failure may develop, which is expressed in a decrease in the antitoxic function of the liver and the accumulation of nitrogenous wastes in the blood. One of the initial signs of hidden liver failure is an increase in the level of bilirubin in the blood. With obvious deficiency, scleral icterus, adynamia, and liver enlargement occur. A relative impairment of the antitoxic function of the liver is observed in the coming days in the majority of patients who have undergone severe interventions. If there are signs of liver failure, a carbohydrate diet with the exception of fat is prescribed; 20 ml of a 40% glucose solution is injected intravenously daily with simultaneous subcutaneous injections of 10-20 units of insulin. Mineral waters are prescribed internally (, No. 17). They give atropine, calcium, bromine, and cardiac medications.

Various violations metabolic processes in the postoperative period. With persistent vomiting and diarrhea, intestinal fistulas, dehydration occurs due to the loss of large amounts of fluid, intestinal contents, bile, etc. Along with the liquid contents, electrolytes are also lost. Disruption of normal water-salt metabolism, especially after severe operations, leads to heart and liver failure, decreased filtration function of the renal glomeruli and decreased diuresis. When acute renal failure occurs, urine flow decreases and stops, blood pressure drops to 40-50 mmHg. Art.

In case of disturbances of water-salt metabolism, drip administration of liquids, electrolytes (Na and K), and oxygen therapy are used; To improve kidney function, a perirenal block is performed. An indicator of improvement in kidney function is the daily excretion of urine in an amount of up to 1500 ml with a specific gravity of about 1015.

In case of exhaustion, suppuration, intoxication after operations on the gastrointestinal tract, a protein balance disorder may occur - hypoproteinemia. In combination with clinical data, the determination of proteins (total protein, albumins, globulins) is of great practical importance, being also one of the functional methods for assessing the condition of the liver, where albumins and part of the globulins are synthesized. To normalize impaired protein metabolism (to increase the amount of albumin by reducing globulins), parenteral administration of protein hydrolysates, serum, dry plasma is used, blood is transfused, and liver function is stimulated with medications.

Postoperative acidosis characterized mainly by a decrease in the alkaline reserve of the blood and, to a lesser extent, an increase in ammonia in the urine, the accumulation of acetone bodies in the urine and an increase in the concentration of hydrogen ions in the blood and urine. The severity of postoperative acidosis depends on the disturbance of carbohydrate metabolism after surgery - hyperglycemia. The complication develops more often in women. The main cause of postoperative hyperglycemia is considered to be a weakening of the oxidative abilities of tissues; liver dysfunction plays a lesser role. Moderate postoperative acidosis does not produce visible clinical manifestations. With severe acidosis, weakness, headache, loss of appetite, nausea, vomiting, and water-salt imbalance are noted. In the most severe cases, drowsiness, respiratory disorders (“big breathing” by Kussmaul), and coma with fatal outcome occur. Cases of this kind are very rare. For uncompensated postoperative moderate and severe acidosis, insulin and glucose therapy is successfully used.

After extensive interventions, especially after complex operations on the thoracic and abdominal organs, the condition often develops hypoxia(oxygen starvation of tissues). Clinically, hypoxia is characterized by cyanosis of the mucous membranes, fingertips, cardiac dysfunction, and deterioration in general well-being. To combat hypoxia, oxygen therapy is used in combination with glucose-insulin therapy.

A serious postoperative complication is hyperthermic syndrome, developing in the immediate hours after surgery as a result of disproportions in heat generation and heat transfer. Patients experience cyanosis, shortness of breath, convulsions, blood pressure drops, temperature rises to 40° and even 41-42°. The etiology of this condition is associated with the onset of cerebral edema. As therapeutic measures, intravenous administration of significant quantities of hypertonic glucose solution and moderate hypothermia are used.

Local complications. Complications in the area of the surgical wound include bleeding, hematoma, infiltration, suppuration of the wound, separation of its edges with prolapse of the viscera (eventration), ligature fistula, and seroma.

Bleeding may occur as a result of insufficient hemostasis during surgery, slipping of the ligature from the vessel, or a blood clotting disorder.

Stopping bleeding is carried out by known methods of final hemostasis (cold application to the wound, tamponade, ligation, hemostatic drugs), and repeated surgical intervention performed for this purpose.

Hematoma is formed in tissues from blood coming from a bleeding vessel. It dissolves under the influence of heat (compress, ultraviolet irradiation (UVR)), and is removed by puncture or surgery.

Infiltrate- this is the impregnation of tissues with exudate at a distance of 5-10 cm from the edges of the wound. The reasons are infection of the wound, traumatization of the subcutaneous fat tissue with the formation of areas of necrosis and hematomas, inadequate drainage of the wound in obese patients, and the use of material with high tissue reactivity for sutures on the subcutaneous fat tissue. Clinical signs of infiltration appear on the 3rd to 6th day after surgery: pain, swelling and hyperemia of the edges of the wound, where a painful compaction without clear contours is palpable, deterioration in general condition, increased body temperature, and the appearance of other symptoms of inflammation and intoxication. Resorption of the infiltrate is also possible under the influence of heat, so physiotherapy is used.

Suppuration of the wound develops for the same reasons as infiltration, but the inflammatory phenomena are more pronounced.

Clinical signs appear towards the end of the first - beginning of the second day after surgery and progress in the following days. Within several days the patient's condition approaches septic.

If the wound suppurates, you need to remove the stitches, separate its edges, release the pus, sanitize and drain the wound.

Eventration- protrusion of organs through a surgical wound - can occur for various reasons: due to deterioration of tissue regeneration (with hypoproteinemia, anemia, vitamin deficiency, exhaustion), insufficiently strong suturing of tissues, suppuration of the wound, a sharp and prolonged increase in intra-abdominal pressure (with flatulence, vomiting, cough, etc.).

The clinical picture depends on the degree of eventration. Prolapse of the viscera most often occurs on the 7th -10th day or earlier with a sharp increase in intra-abdominal pressure and is manifested by the divergence of the edges of the wound, the exit of organs through it, which can result in the development of their inflammation and necrosis, intestinal obstruction, and peritonitis.

During eventration, the wound should be covered with a sterile bandage moistened with an antiseptic solution. In the operating room under general anesthesia, the surgical field and prolapsed organs are treated with antiseptic solutions; the latter are straightened, the edges of the wound are tightened with strips of plaster or strong suture material and reinforced with tight abdominal bandaging and a tight bandage. The patient is prescribed strict bed rest for 2 weeks and stimulation of intestinal activity.

Ligature fistula appears as a result of infection of non-absorbable suture material (especially silk) or individual intolerance to the suture material by the macroorganism. An abscess forms around the material, which opens in the area of the postoperative scar.

The clinical manifestation of a ligature fistula is the presence of a fistula tract through which pus is released with pieces of the ligature.

Treatment of a ligature fistula involves revision of the fistula tract with a clamp, which allows you to find the thread and remove it. In case of multiple fistulas, as well as a long-lasting single fistula, an operation is performed - excision of the postoperative scar with the fistula tract. After removing the ligature, the wound heals quickly.

Seroma- accumulation of serous fluid - occurs due to the intersection of lymphatic capillaries, the lymph of which collects in the cavity between the subcutaneous fatty tissue and the aponeurosis, which is especially pronounced in obese people in the presence of large cavities between these tissues.

Clinically, seroma is manifested by the discharge of straw-colored serous fluid from the wound.

Treatment of seroma, as a rule, is limited to one- or two-time evacuation of this wound discharge in the first 2-3 days after surgery. Then the formation of seroma stops.

General complications. Such complications arise as a result of the general impact of surgical trauma on the body and are manifested by dysfunction of organ systems.

Most often after surgery, pain is observed in the area of the postoperative wound. To reduce it, narcotic or non-narcotic analgesics with analeptics are prescribed for 2 - 3 days after surgery or a mixture of antispasmodics with analgesics and desensitizing agents.

Complications from the nervous system. Insomnia is often observed after surgery, and mental disorders are much less common. For insomnia, sleeping pills are prescribed. Mental disorders occur in weakened patients and alcoholics after traumatic operations. If psychosis develops, an individual post should be established and the doctor on duty or a psychiatrist should be called. To calm patients, thorough anesthesia is performed and antipsychotics (haloperidol, droperidol) are used.

Complications from the respiratory system. Bronchitis, postoperative pneumonia, and atelectasis occur as a result of impaired ventilation of the lungs, hypothermia, and most often develop in smokers. Before surgery and in the postoperative period, patients are strictly prohibited from smoking. To prevent pneumonia and atelectasis, patients are given breathing exercises, vibration massage, chest massage, cupping and mustard plasters, oxygen therapy, and a semi-sitting position in bed. Hypothermia must be avoided. To treat pneumonia, antibiotics, cardiac drugs, analeptics and oxygen therapy are prescribed. If severe respiratory failure develops, a tracheostomy is applied or the patient is intubated with breathing apparatus connected.

Complications from the cardiovascular system. The most dangerous is acute cardiovascular failure - left ventricular or right ventricular. With left ventricular failure, pulmonary edema develops, characterized by the appearance of severe shortness of breath, fine wheezing in the lungs, increased heart rate, a drop in arterial pressure and an increase in venous pressure. To prevent these complications, it is necessary to carefully prepare patients for surgery, measure blood pressure, pulse, and administer oxygen therapy. As prescribed by the doctor, cardiac medications (corglycon, strophanthin), antipsychotics are administered to adequately replenish blood loss.

Acute thrombosis and embolism develop in severely ill patients with increased blood clotting, the presence of cardiovascular diseases, and varicose veins. In order to prevent these complications, the legs are bandaged with elastic bandages and the limbs are placed in an elevated position. After the operation, the patient should begin to walk early. As prescribed by the doctor, antiplatelet agents (reopolyglucin, trental) are used; if blood clotting increases, heparin is prescribed under the control of clotting time or low molecular weight heparins (fraxiparin, clexane, fragmin), and coagulogram parameters are examined.

Digestive complications. Due to insufficient oral care, stomatitis (inflammation of the oral mucosa) and acute parotitis (inflammation of the salivary glands) can develop, therefore, to prevent these complications, thorough oral hygiene is necessary (rinsing with antiseptic solutions and treating the oral cavity with potassium permanganate, using chewing gum or lemon slices to stimulate salivation).

A dangerous complication is paresis of the stomach and intestines, which can manifest itself as nausea, vomiting, flatulence, non-excretion of gases and feces. For the purpose of prevention, a nasogastric tube is inserted into the patients’ stomach, the stomach is washed and the gastric contents are evacuated, and Cerucal or Raglan is administered parenterally from the first days after surgery. A gas outlet tube is inserted into the rectum, and in the absence of contraindications, a hypertensive enema is used. To treat paresis, as prescribed by a doctor, proserin is administered to stimulate the intestines, hypertonic solutions of sodium and potassium chlorides are administered intravenously, an Ognev enema is used (10% sodium chloride solution, glycerin, hydrogen peroxide 20.0 ml), perinephric or epidural blockade, and hyperbaric therapy are performed.

Complications from the genitourinary system: The most common symptoms are urinary retention and bladder overflow. In this case, patients complain of severe pain above the womb. In these cases, it is necessary to isolate the patient with a screen or place him in a separate room, reflexively induce urination with the sound of a falling stream of water, and apply heat to the pubic area. If there is no effect, catheterization of the bladder is performed with a soft catheter.

To prevent urinary retention, the patient should be taught to urinate in a duck while lying in bed before surgery.

Skin complications. Bedsores more often develop in exhausted and weakened patients, with a long-term forced position of the patient on his back, trophic disorders due to damage to the spinal cord. Prevention requires careful skin care, an active position in bed or turning the patient over, and timely change of underwear and bed linen. Sheets should be free of wrinkles and crumbs.

Cotton-gauze rings, a backing circle, and an anti-decubitus mattress are effective. When bedsores occur, chemical antiseptics (potassium permanganate), proteolytic enzymes, wound healing agents, and excision of necrotic tissue are used.

Timing for suture removal

The timing of suture removal is determined by many factors: the anatomical region, its trophism, the regenerative characteristics of the body, the nature of the surgical intervention, the patient’s condition, his age, the characteristics of the disease, the presence of local complications of the surgical wound.

When a surgical wound heals by primary intention, the formation of a postoperative scar occurs on the 6th - 16th day, which allows the sutures to be removed within these periods.

So, sutures are removed after operations:

· on the head - on the 6th day;

· associated with a small opening of the abdominal wall (appendectomy, hernia repair) - on days 6-7;

· requiring a wide opening of the abdominal wall (laparotomy or transection) - on days 9-12;

· on the chest (thoracotomy) - on the 10-14th day;

· after amputation - on the 10-14th day;

· in elderly, weakened and cancer patients due to reduced regeneration - on the 14-16th day.

Rice. 9.1. Removing surgical sutures

Sutures placed on the skin and mucous membranes can be removed by a nurse in the presence of a doctor. The sutures are removed using scissors and tweezers (Fig. 9.1). Using tweezers, grab one of the ends of the knot and pull it in the opposite direction along the suture line until a white piece of ligature appears from the depths of the tissue. In the area of the white segment, the thread is crossed with scissors or a scalpel. Using tweezers, remove the ligature with an energetic upward movement so that the portion of the ligature that was on the surface of the skin is not pulled through the tissue. A continuous seam is removed with separate stitches using the same principle. The removed threads are thrown into a tray or basin. The area of the postoperative scar is treated with a 1% iodonate solution and covered with a sterile bandage.

Control questions

1. What is a surgical operation? Name the types of surgical operations.

2. Name the stages of surgical operations.

3. What are the names of the operations of removing the stomach for stomach cancer, removing part of the mammary gland for a benign tumor, removing the sigmoid colon onto the anterior abdominal wall for rectal trauma?

4. What effect does surgery have on the patient’s body?

5. What is the preoperative period? What tasks are solved in the preoperative period?

6. What is the importance of the preoperative period for the prevention of complications associated with surgery?

7. What is the preparation of the patient for surgery?

8. What tests can determine dysfunction of the circulatory system?

9. What tests can detect respiratory dysfunction?

10. How to determine the functional state of the liver?

11. What tests are used to determine whether kidney function is impaired?

12. What is the postoperative period called? Name the phases of the postoperative period.

13. What is called the normal and complicated course of the postoperative period?

14. Name the main postoperative complications.

– Early – as a rule, develops in the first 7 days after surgery;

– Late – develops at various times after discharge from the hospital

From the side of the wound:

1. Bleeding from a wound

2. Wound suppuration

3. Eventration

4. Postoperative hernias

5. Ligature fistulas

From the side of the operated organ (anatomical area):

– Failure of anastomotic sutures (stomach, intestines, bronchus, etc.).

- Bleeding.

– Formation of strictures, cysts, fistulas (internal or external).

– Paresis and paralysis.

– Purulent complications (abscesses, phlegmon, peritonitis, pleural empyema, etc.).

From other organs and systems:

– From the cardiovascular system – acute coronary insufficiency, myocardial infarction, thrombosis and thrombophlebtitis, pulmonary embolism;

– From the central nervous system – acute cerebrovascular accident (stroke), paresis and paralysis;

– Acute renal, liver failure.

- Pneumonia.

Postoperative complications can be presented in the form of a diagram

Care begins immediately after surgery. If the operation was performed under anesthesia, permission for transportation is given by the anesthesiologist. With local anesthesia, the patient is moved onto a gurney after surgery either independently or with the help of staff, after which he is transported to the recovery room or to a ward in the surgical department.

Sick bed should be prepared for the moment of his arrival from the operating room: covered with fresh linen, heated with heating pads, there should be no folds on the sheets. The nurse must know what position the patient should be in after surgery. Patients usually lie on their back. Sometimes after surgery on the abdominal and thoracic cavities, patients lie in the Fowler's position (a semi-sitting position on the back with the limbs bent at the knee joints).

Patients operated on under anesthesia are transported to the intensive care unit on a bed in the same department. Transfer from the operating table to a functional bed is carried out under the supervision of an anesthesiologist. The unconscious patient is carefully lifted from the operating table and placed on the bed, while sharp flexion of the spine (possible dislocation of the vertebrae) and hanging limbs (possible dislocation) should be avoided. It is also necessary to ensure that the bandage from the postoperative wound is not torn off and the drainage tubes are not removed. At the time of transferring the patient to the bed and transporting, signs of respiratory and cardiac disturbances may occur, therefore the support of an anesthesiologist and nurse anesthetist Necessarily . Until the patient regains consciousness, he is laid horizontally, his head is turned to the side (prevention of aspiration of gastric contents into the bronchi - the nurse should be able to use an electric suction to help the patient with vomiting). Cover with a warm blanket.

To better provide the body with oxygen, humidified oxygen is supplied through a special device. To reduce bleeding of operated tissues, an ice pack or a weight (usually a sealed oilcloth bag with sand) is placed on the wound area for 2 hours. Drainage tubes are attached to the system to collect the contents of a wound or cavity.

In the first 2 hours, the patient is in a horizontal position on his back or with the head end down, since in this position the blood supply to the brain is better ensured.

During operations under spinal anesthesia, the horizontal position is maintained for 4-6 hours due to the risk of developing orthostatic hypotension.

After the patient regains consciousness, a pillow is placed under his head, and his hips and knees are raised to reduce blood stagnation in the calf muscles (prevention of thrombosis).

The optimal position in bed after surgery may vary, depending on the nature and area of surgery. For example, patients who have undergone surgery on the abdominal organs, after they regain consciousness, are placed in bed with their heads slightly raised and legs slightly bent at the knees and hip joints.

A long stay of the patient in bed is not advisable, due to the high risk of complications caused by physical inactivity. Therefore, all factors that deprive him of mobility (drains, long-term intravenous infusions) must be taken into account in time. This is especially true for elderly and senile patients.

There are no clear criteria defining the timing of a patient getting out of bed. Most patients are allowed to get up 2-3 days after surgery, but the introduction of modern technologies into medical practice changes a lot. After laparoscopic cholecystectomy, you are allowed to get up in the evening, and many patients are discharged for outpatient treatment the very next day. Getting up early increases confidence in a favorable outcome of the operation, reduces the frequency and severity of postoperative complications, especially respiratory and deep vein thrombosis.

Even before surgery, it is necessary to teach the patient the rules of getting out of bed. In the evening or the next morning, the patient should sit on the edge of the bed, clear his throat, move his legs, and in bed he should change his body position as often as possible and make active movements with his legs. At the beginning, the patient is turned on his side, on the side of the wound, with his hips and knees bent, with his knees on the edge of the bed; the doctor or nurse helps the patient sit down. Then, after taking several deep breaths and exhalations, the patient clears his throat, stands on the floor, takes 10-12 steps around the bed, and goes back to bed. If the patient’s condition does not worsen, then the patient should become more active in accordance with his own feelings and the doctor’s instructions.

Sitting in bed or a chair is not recommended due to the risk of slowing venous blood flow and causing thrombosis in the deep veins of the lower extremities, which in turn can cause sudden death due to blood clot rupture and pulmonary embolism.

To timely identify this complication, it is necessary to measure the circumference of the limb daily and palpate the calf muscles in the projection of the neurovascular bundle. The appearance of signs of deep vein thrombosis (swelling, bluishness of the skin, increased volume of the limb) is an indication for special diagnostic methods (ultrasound Dopplerography, venography). Deep vein thrombosis occurs especially often after traumatological and orthopedic operations, as well as in patients with obesity, cancer, and diabetes. Reducing the risk of thrombosis in the postoperative period is facilitated by the restoration of impaired water-electrolyte metabolism, the prophylactic use of direct-acting anticoagulants (heparin and its derivatives), early activation of the patient, and bandaging the lower extremities with elastic bandages before surgery and in the first 10-12 days after it.

Update: October 2018

Hysterectomy or removal of the uterus is a fairly common operation that is performed for certain indications. According to statistics, approximately a third of women who have crossed the 45-year mark have undergone this operation.

And, of course, the main question that concerns patients who have undergone surgery or are preparing for surgery is: “What consequences can there be after removal of the uterus”?

Postoperative period

As you know, the period of time that lasts from the date of surgical intervention to restoration of ability to work and good health is called the postoperative period. Hysterectomy is no exception. The period after surgery is divided into 2 “sub-periods”:

early
late postoperative periods

During the early postoperative period, the patient is in the hospital under the supervision of doctors. Its duration depends on the surgical approach and the general condition of the patient after surgery.

After surgery to remove the uterus and/or appendages, which was carried out either vaginally or through an incision in the anterior wall of the abdomen, the patient remains in the gynecological department for 8 - 10 days, and it is at the end of the agreed period that the sutures are removed.
After laparoscopic hysterectomy the patient is discharged after 3–5 days.

The first day after surgery

The first postoperative days are especially difficult.

Pain - during this period, the woman feels significant pain both inside the abdomen and in the area of the sutures, which is not surprising, since there is a wound both outside and inside (just remember how painful it is when you accidentally cut your finger). To relieve pain, non-narcotic and narcotic painkillers are prescribed.

Lower limbs remain, as before the operation, in or bandaged with elastic bandages (prevention of thrombophlebitis).

Activity - surgeons adhere to active management of the patient after surgery, which means getting out of bed early (after laparoscopy in a few hours, after laparotomy in a day). Physical activity “accelerates the blood” and stimulates intestinal function.

Diet - the first day after a hysterectomy, a gentle diet is prescribed, which contains broths, pureed food and liquids (weak tea, still mineral water, fruit drinks). Such a treatment table gently stimulates intestinal motility and promotes early (1–2 days) spontaneous bowel movement. Independent stool indicates the normalization of intestinal function, which requires a transition to regular food.

Belly after hysterectomy remains painful or sensitive for 3–10 days, which depends on the patient’s pain sensitivity threshold. It should be noted that the more active the patient is after surgery, the faster her condition recovers and the lower the risk of possible complications.

Treatment after surgery

Antibiotics - usually antibacterial therapy is prescribed for prophylactic purposes, since the patient’s internal organs came into contact with air during the operation, and therefore with various infectious agents. The course of antibiotics lasts an average of 7 days.
Anticoagulants - also in the first 2 - 3 days, anticoagulants (blood thinning drugs) are prescribed, which are designed to protect against thrombosis and the development of thrombophlebitis.
Intravenous infusions- in the first 24 hours after hysterectomy, infusion therapy (intravenous drip infusion of solutions) is carried out in order to replenish the volume of circulating blood, since the operation is almost always accompanied by significant blood loss (the volume of blood loss during an uncomplicated hysterectomy is 400 - 500 ml).

The course of the early postoperative period is considered smooth if there are no complications.

Early postoperative complications include:

inflammation of the postoperative scar on the skin (redness, swelling, purulent discharge from the wound and even dehiscence);
problems with urination(pain or pain when urinating) caused by traumatic urethritis (damage to the mucous membrane of the urethra);
bleeding of varying intensity, both external (from the genital tract) and internal, which indicates insufficiently well-performed hemostasis during surgery (discharge may be dark or scarlet, blood clots are present);
pulmonary embolism- a dangerous complication that leads to blockage of the branches or the pulmonary artery itself, which is fraught with pulmonary hypertension in the future, the development of pneumonia and even death;
peritonitis - inflammation of the peritoneum, which spreads to other internal organs, dangerous for the development of sepsis;
hematomas (bruises) in the area of the sutures.

Bloody discharge after removal of the uterus, like a “daub,” is always observed, especially in the first 10–14 days after the operation. This symptom is explained by the healing of sutures in the area of the uterine stump or in the vaginal area. If a woman’s discharge pattern changes after surgery:

accompanied by an unpleasant, putrid odor
the color resembles meat slop

You should consult a doctor immediately. It is possible that inflammation of the sutures in the vagina has occurred (after hysterectomy or vaginal hysterectomy), which is fraught with the development of peritonitis and sepsis. Bleeding from the genital tract after surgery is a very alarming signal and requires repeat laparotomy.

Suture infection

If a postoperative suture becomes infected, the general body temperature rises, usually not higher than 38 degrees. The patient’s condition, as a rule, does not suffer. Prescribed antibiotics and treatment of sutures are quite enough to relieve this complication. The first time the postoperative dressing is changed and the wound is treated the next day after the operation, then the dressing is carried out every other day. It is advisable to treat the sutures with a solution of Curiosin (10 ml, 350-500 rubles), which ensures gentle healing and prevents the formation of a keloid scar.

Peritonitis

The development of peritonitis more often occurs after a hysterectomy performed for emergency reasons, for example, necrosis of a myomatous node.

The patient's condition deteriorates sharply
The temperature “jumps” to 39 – 40 degrees
Pronounced pain syndrome
Signs of peritoneal irritation are positive
In this situation, massive antibiotic therapy is carried out (prescription of 2–3 drugs) and infusion of saline and colloid solutions
If there is no effect from conservative treatment, surgeons perform relaparotomy, remove the uterine stump (in case of uterine amputation), wash the abdominal cavity with antiseptic solutions and install drainages

The hysterectomy slightly changes the patient’s usual lifestyle. For a quick and successful recovery after surgery, doctors give patients a number of specific recommendations. If the early postoperative period proceeded smoothly, then after the woman’s stay in the hospital expires, she should immediately take care of her health and the prevention of long-term consequences.

Bandage

A good help in the late postoperative period is wearing a bandage. It is especially recommended for premenopausal women who have had a history of multiple births or for patients with weakened abdominal muscles. There are several models of such a supportive corset; you should choose the model in which the woman does not feel discomfort. The main condition when choosing a bandage is that its width must exceed the scar by at least 1 cm above and below (if an inferomedial laparotomy was performed).

Sex life, weight lifting

Discharge after surgery continues for 4 to 6 weeks. For one and a half, and preferably two months after a hysterectomy, a woman should not lift weights of more than 3 kg and perform heavy physical work, otherwise this could lead to the rupture of internal sutures and abdominal bleeding. Sexual activity during the specified period is also prohibited.

Special exercises and sports

To strengthen the vaginal and pelvic muscles, it is recommended to perform special exercises using an appropriate simulator (perineal gauge). It is the simulator that creates resistance and ensures the effectiveness of such intimate gymnastics.

The described exercises (Kegel exercises) got their name from a gynecologist and developer of intimate gymnastics. You must perform at least 300 exercises per day. Good tone of the vaginal and pelvic floor muscles prevents prolapse of the vaginal walls, prolapse of the uterine stump in the future, as well as the occurrence of such an unpleasant condition as urinary incontinence, which almost all women in menopause face.

Sports after a hysterectomy are easy physical activity in the form of yoga, Bodyflex, Pilates, shaping, dancing, swimming. You can start classes only 3 months after the operation (if it was successful, without complications). It is important that physical education during the recovery period brings pleasure and does not exhaust the woman.

About baths, saunas, and the use of tampons

For 1.5 months after surgery, it is prohibited to take baths, visit saunas, steam baths and swim in open water. While there is spotting, you should use sanitary pads, but not tampons.

Nutrition, diet

Proper nutrition is of no small importance in the postoperative period. To prevent constipation and gas formation, you should consume more liquid and fiber (vegetables, fruits in any form, wholemeal bread). It is recommended to give up coffee and strong tea, and, of course, alcohol. Food should not only be fortified, but contain the required amount of proteins, fats and carbohydrates. A woman should consume most of her calories in the first half of the day. You will have to give up your favorite fried, fatty and smoked foods.

Sick leave

The total period of incapacity for work (counting the time spent in the hospital) ranges from 30 to 45 days. If any complications arise, the sick leave is naturally extended.

Hysterectomy: what then?

In most cases, women after surgery face psycho-emotional problems. This is due to the existing stereotype: there is no uterus, which means there is no main female distinctive feature, and accordingly, I am not a woman.

In reality, this is not the case. After all, it is not only the presence of a uterus that determines a woman’s essence. To prevent the development of depression after surgery, you should study the issue regarding removal of the uterus and life after it as carefully as possible. After the operation, the husband can provide significant support, because outwardly the woman has not changed.

Fears regarding changes in appearance:

increased facial hair growth

decreased sex drive

weight gain

changing voice timbre, etc.

are far-fetched and therefore easily overcome.

Sex after hysterectomy

Sexual intercourse will give the woman the same pleasures as before, since all sensitive areas are located not in the uterus, but in the vagina and external genitalia. If the ovaries are preserved, then they continue to function as before, that is, they secrete the necessary hormones, especially testosterone, which is responsible for sexual desire.

In some cases, women even note an increase in libido, which is facilitated by relief from pain and other problems associated with the uterus, as well as a psychological moment - the fear of unwanted pregnancy disappears. Orgasm will not disappear after amputation of the uterus, and some patients experience it more vividly. But the occurrence of discomfort and even...

This point applies to those women who have had a hysterectomy (a scar in the vagina) or a radical hysterectomy (Wertheim operation), in which part of the vagina is excised. But this problem is completely solvable and depends on the degree of trust and mutual understanding of the partners.

One of the positive aspects of the operation is the absence of menstruation: no uterus - no endometrium - no menstruation. This means goodbye to critical days and the troubles associated with them. But it’s worth mentioning that, rarely, women who have undergone uterine amputation while preserving the ovaries may experience slight spotting on menstruation. This fact is explained simply: after amputation, a uterine stump remains, and therefore a little endometrium. Therefore, you should not be afraid of such discharges.

Loss of fertility

The issue of loss of reproductive function deserves special attention. Naturally, since there is no uterus - the place of fruit, pregnancy is impossible. Many women list this fact as a plus for having a hysterectomy, but if the woman is young, this is definitely a minus. Before suggesting removal of the uterus, doctors carefully assess all risk factors, study the medical history (in particular the presence of children) and, if possible, try to preserve the organ.

If the situation allows, the woman either has myomatous nodes excised (conservative myomectomy) or the ovaries are left behind. Even with an absent uterus, but preserved ovaries, a woman can become a mother. IVF and surrogacy are a real way to solve the problem.

Suture after hysterectomy

The suture on the anterior abdominal wall worries women no less than other problems associated with hysterectomy. Laparoscopic surgery or a transverse incision in the lower abdomen will help to avoid this cosmetic defect.

Adhesive process

Any surgical intervention in the abdominal cavity is accompanied by the formation of adhesions. Adhesions are connective tissue cords that form between the peritoneum and internal organs, or between organs. Almost 90% of women suffer from adhesive disease after a hysterectomy.

Forced penetration into the abdominal cavity is accompanied by damage (dissection of the peritoneum), which has fibrinolytic activity and ensures lysis of fibrinous exudate, gluing the edges of the dissected peritoneum.

An attempt to close the area of the peritoneal wound (suturing) disrupts the process of melting of early fibrinous deposits and promotes increased adhesions. The process of formation of adhesions after surgery depends on many factors:

duration of the operation;
volume of surgical intervention (the more traumatic the operation, the higher the risk of adhesions);
blood loss;
internal bleeding, even leakage of blood after surgery (resorption of blood provokes adhesions);
infection (development of infectious complications in the postoperative period);
genetic predisposition (the more the genetically determined enzyme N-acetyltransferase, which dissolves fibrin deposits, is produced, the lower the risk of adhesive disease);
asthenic physique.

pain (constant or intermittent)
urination and defecation disorders
, dyspeptic symptoms.

To prevent the formation of adhesions in the early postoperative period, the following are prescribed:

antibiotics (suppress inflammatory reactions in the abdominal cavity)
anticoagulants (thin the blood and prevent the formation of adhesions)
motor activity already on the first day (turning on its side)
early start of physiotherapy (ultrasound or, Hyaluronidase, and others).

Properly carried out rehabilitation after a hysterectomy will prevent not only the formation of adhesions, but also other consequences of the operation.

Menopause after hysterectomy

One of the long-term consequences of hysterectomy surgery is menopause. Although, of course, any woman sooner or later approaches this milestone. If during the operation only the uterus was removed, but the appendages (tubes with ovaries) were preserved, then the onset of menopause will occur naturally, that is, at the age for which the woman’s body is “programmed” genetically.

However, many doctors are of the opinion that after surgical menopause, menopausal symptoms develop on average 5 years earlier than expected. There are no exact explanations for this phenomenon yet; it is believed that the blood supply to the ovaries after a hysterectomy somewhat deteriorates, which affects their hormonal function.

Indeed, if we recall the anatomy of the female reproductive system, the ovaries are mostly supplied with blood from the uterine vessels (and, as is known, quite large vessels pass through the uterus - the uterine arteries).

To understand the problems of menopause after surgery, it is worth defining the medical terms:

natural menopause - cessation of menstruation due to the gradual fading of the hormonal function of the gonads (see)
artificial menopause - cessation of menstruation (surgical - removal of the uterus, medication - suppression of ovarian function with hormonal drugs, radiation)
surgical menopause – removal of both the uterus and ovaries

Women endure surgical menopause more severely than natural menopause, this is due to the fact that when natural menopause occurs, the ovaries do not immediately stop producing hormones; their production decreases gradually, over several years, and eventually stops.

After removal of the uterus and appendages, the body undergoes a sharp hormonal change, since the synthesis of sex hormones suddenly stopped. Therefore, surgical menopause is much more difficult, especially if a woman is of childbearing age.

Symptoms of surgical menopause appear within 2–3 weeks after surgery and are not much different from the signs of natural menopause. Women are concerned about:

tides (see)
sweating ()
emotional lability
Depressive states often occur (see and)
later dryness and aging of the skin occur
brittleness of hair and nails ()
urinary incontinence when coughing or laughing ()
Vaginal dryness and related sexual problems
decreased sex drive

In case of removal of both the uterus and ovaries, hormone replacement therapy is necessary, especially for women under 50 years of age. For this purpose, both gestagens and testosterone are used, which is mostly produced in the ovaries and a decrease in its level leads to a weakening of libido.

If the uterus and appendages were removed due to large myomatous nodes, then the following is prescribed:

continuous estrogen monotherapy, used as oral tablets (Ovestin, Livial, Proginova and others),
products in the form of suppositories and ointments for the treatment of atrophic colpitis (Ovestin),
as well as preparations for external use (Estrogel, Divigel).

If a hysterectomy with adnexa was performed for internal endometriosis:

treatment with estrogens (Kliane, Progynova)
together with gestagens (suppression of the activity of dormant foci of endometriosis)

Hormone replacement therapy should be started as early as possible, 1 to 2 months after the hysterectomy. Hormone treatment significantly reduces the risk of cardiovascular disease, osteoporosis and Alzheimer's disease. However, hormone replacement therapy may not be prescribed in all cases.

Contraindications to treatment with hormones are:

surgery for ;
pathology of the veins of the lower extremities (thrombophlebitis, thromboembolism);
severe pathology of the liver and kidneys;
meningioma.

The duration of treatment ranges from 2 to 5 or more years. You should not expect immediate improvement and disappearance of menopausal symptoms immediately after starting treatment. The longer hormone replacement therapy is carried out, the less pronounced the clinical manifestations are.

Other long-term consequences

One of the long-term consequences of hysterovariectomy is the development of osteoporosis. Men are also susceptible to this disease, but the fairer sex suffers from it more often (see). This pathology is associated with a decrease in estrogen production, so in women osteoporosis is more often diagnosed during pre- and postmenopausal periods (see).

Osteoporosis is a chronic disease that is prone to progression and is caused by a metabolic disorder of the skeleton such as the leaching of calcium from the bones. As a result, the bones become thinner and brittle, which increases the risk of fractures. Osteoporosis is a very insidious disease; it occurs latently for a long time and is detected in an advanced stage.

The most common fractures occur in the vertebral bodies. Moreover, if one vertebra is damaged, there is no pain as such; severe pain is typical for simultaneous fractures of several vertebrae. Spinal compression and increased bone fragility lead to spinal curvature, changes in posture and decreased height. Women with osteoporosis are susceptible to traumatic fractures.

The disease is easier to prevent than to treat (see), therefore, after amputation of the uterus and ovaries, hormone replacement therapy is prescribed, which inhibits the leaching of calcium salts from the bones.

Nutrition and exercise

You also need to follow a certain diet. The diet should contain:

dairy products
all varieties of cabbage, nuts, dried fruits (dried apricots, prunes)
legumes, fresh vegetables and fruits, greens
You should limit your salt intake (promotes the excretion of calcium by the kidneys), caffeine (coffee, Coca-Cola, strong tea) and avoid alcoholic beverages.

To prevent osteoporosis, it is useful to exercise. Physical exercise improves muscle tone and increases joint mobility, which reduces the risk of fractures. Vitamin D plays an important role in the prevention of osteoporosis. Consuming fish oil and ultraviolet irradiation will help compensate for its deficiency. The use of calcium-D3 Nycomed in courses of 4 to 6 weeks replenishes the lack of calcium and vitamin D3 and increases bone density.

Vaginal prolapse

Another long-term consequence of hysterectomy is prolapse of the vagina.

Firstly, prolapse is associated with trauma to the pelvic tissue and supporting (ligament) apparatus of the uterus. Moreover, the wider the scope of the operation, the higher the risk of prolapse of the vaginal walls.
Secondly, prolapse of the vaginal canal is caused by the prolapse of neighboring organs into the freed pelvis, which leads to cystocele (prolapse of the bladder) and rectocele (prolapse of the rectum).

To prevent this complication, women are advised to perform Kegel exercises and limit heavy lifting, especially in the first 2 months after hysterectomy. In advanced cases, surgery is performed (vaginoplasty and its fixation in the pelvis by strengthening the ligamentous apparatus).

Forecast

Hysterectomy not only does not affect life expectancy, but even improves its quality. Having gotten rid of the problems associated with diseases of the uterus and/or appendages, forever forgetting about the issues of contraception, many women literally blossom. More than half of the patients note liberation and increased libido.

Disability after removal of the uterus is not granted, since the operation does not reduce the woman’s ability to work. A disability group is assigned only in cases of severe uterine pathology, when hysterectomy entailed radiation or chemotherapy, which significantly affected not only the ability to work, but also the patient’s health.