Recovery after laparoscopy surgery. Laparoscopy of the fallopian tubes postoperative period. General conditions for proper nutrition

As the title of the review says, laparoscopy, like some kind of exciting adventure, has been present in my life as many as 3 times.

1. - Diagnostic laparoscopy, with suspicion of appendicitis (it turned out that it was a cyst, but they did not dare to operate due to the doctor’s low level of qualifications)

2. - A month later, laparoscopy with removal of a dermoid cyst on the ovary. Ovarian resection

3. - After 4 years - laparoscopy and removal of a dermoid cyst on the second ovary

I would never have thought that I would be able to calmly write my review about laparoscopy from the confident position of an “experienced” person - I was afraid of the first operation like fire, reading frightening stories on the Internet. When I asked my surgeon, with hysterical notes in my voice, “But this is a simple operation, right?,” my auntie, a surgeon with incredible work experience, barked something like, “There are no simple operations, don’t talk to me about it!” And they knocked me out. me under anesthesia) But, first things first.

How it happened to me during my last laparoscopy

PREPARATION FOR LAPAROSCOPY OF THE OVARY

The first day of hospitalization (Monday), the operation was scheduled for Wednesday. Examination by the doctor, checking into the ward, meeting the girls who will then look after me

On Tuesday morning I had breakfast, for lunch I was only allowed to drink broth from the soup and in the evening instead of dinner - sweet tea. That's it, you can't eat anymore. An anesthesiologist came to meet me, examined me, and told me how the anesthesia would proceed.

Tuesday evening - shaking hands, nervous text messages to mom, a cleansing enema and a sedative for the night)

DAY OF OPERATION

They woke me up at 6 am and sent me to jump on the toilet for a second enema.

After this, they were ordered to wait in the room and not to move. But I’m a girl with a lot of hospital experience - I quickly took a shower and washed my hair - after the operation you won’t be able to wash yourself for a long time (and who wants to lie in Anyuchka). At 9:30 a nurse came, inserted a urinary catheter (unpleasant, I felt like I really wanted to go to the toilet), and at 10:00, to the sympathetic sighs of my roommates, I was taken on a gurney to the operating room.

In the operating room, I lay down on the table, tried to joke with the surgeons out of habit, but they quickly put an IV in my vein and told me to prepare for the operation (smear my tummy and legs with an antiseptic)

By the way, ladies! Be prepared for the fact that your stomach, even if it has a very thin fluff, may be forced to shave - these are the rules (not everywhere, but in many hospitals). Having been warned, I depilated everywhere in advance to the state of a smooth peach (well, or nectarine).

Then the anesthesiologist put a mask on my face, stroked my head (well, he sympathizes, such a good guy) and asked me to breathe deeply, on the third breath I fell asleep, and woke up in the intensive care unit, where all patients are taken after surgery.

EXIT FROM NARCOSIS

I woke up, intensive care. Um, did I even have surgery? I lift the blanket that the medical staff carefully covered me with - damn, yes, they operated on me. There are 3 patches on the belly - I already know that there are stitches under them and a drainage sticks out from the left side - a tube through which blood and excess liquid oozes into the bottle (I was no longer afraid of this either, we were scared).

After the operation in the evening you are allowed to sit up in bed. I wanted to recover so quickly that I begged the nurses to pick me up, walk around the room, and then I walked along the long corridor to the toilet and back. They were strongly against it, but my motivation “princesses don’t pee in ducks” had an effect on them and they gave in without a fight

In general, the more you move in the following days, the it will pass faster recovery and the less likely there will be adhesions (with the doctor’s permission, of course).

Yes, my shoulders hurt a lot - all because of the gas that had accumulated in them, which was used to fill the abdominal cavity during the operation. When the stitches were removed, I was shocked - on one side, instead of a neat scar, a scab 2 centimeters in diameter was waiting for me. Fainting and sobbing were close, but I pulled myself together - the most important thing is that I am alive and well, and I don’t care about the rest!

As a result, most people only notice my scars after I show them to them, but I don’t notice them at all.

For me, every scar from laparoscopy is my victory over the disease, from which I emerged victorious! Like Xena Warrior Princess, only better

RETURN TO USUAL MODE.

RECOVERY AFTER LAPAROSCOPY

After laparoscopy, rest is required, but recovery occurs much faster than after abdominal surgery, so in the absence of complications, returning to work is possible within a week or two after the operation.

My operating doctor warned me that for 2 months after ovarian laparoscopy I am contraindicated hot bath, lifting weights (more than 2 kg) and intense sports.

Intimate life is possible no earlier than 2-3 weeks after the operation, and pregnancy after laparoscopy can be planned almost immediately, as my doctor said, “This way there are even more chances.”

Yes, laparoscopy is primarily an operation, with all its disadvantages and painful sensations. But with optimism, faith in the professionalism of your doctor and a positive attitude, it will seem like just an unpleasant procedure that you can easily forget about immediately after discharge.

I wish all the girls feminine happiness and good health!

__________________________________________________________

I decided to add useful tips and observations for girls who are about to undergo surgery.

10 LIFE HACKS FOR THOSE WHO ARE GOING TO HAVE A LAPAROSCOPY

• If the Hospital is an ordinary, city one, then the medical staff usually advises you to bring a cup, plate, fork, spoon with you to hospitalization. I recommend taking a few more tea bags and sugar to add glucose to the body and be able to avoid collapsing into a hungry faint when the doctors no longer allow you to eat.

• Don't forget to take with you gaskets. Often, the day after laparoscopy, menstruation or other bleeding may begin.

• After the operation I feel thirsty (so much that it’s like I dined on a box of champagne in one person). Getting out of bed to drink from a glass or bottle is quite difficult, so it would be a good idea to bring some from home. a tube (straw) for water.

• Charge your phone. If the operation is in the morning, then you can call your family later in the evening, and it is better that the phone is fully ready)

• Prepare in advance and put on the very top of the bag (or put it in a separate bag) things that you may need after laparoscopy (comfortable panties, pajamas, a robe, pads, a bottle of water, a phone charger, a lip hygienic bag). This will make it much easier for the nurse to help you without digging through all the trunks)

• Clothes after surgery should be as free as possible. These can be loose pants or nighties, but it’s most comfortable when nothing puts pressure on the stomach

• It’s better to take Linux or others with you to the hospital drugs that restore flora. Antibiotics are killing her mercilessly. For the same reason, if there is a problem with thrush, it is better to grab the appropriate medications to stop the harmful candida in time

Do me a favor - put a PLUS if my review was useful to you!

Laparoscopy (from other Greek “laparo” - womb, “scopy” - I look) refers to a modern, low-traumatic type surgical treatment pathologies internal organs. This type of surgical treatment is an excellent alternative to traditional operations, as it is as gentle as possible for the patient. However, you should not take any surgical intervention lightly: after all, any medical manipulation can have unpleasant complications. What do you need to know about laparoscopy, what are its weak and strengths, and what complications may occur after laparoscopy.

Laparoscopy is a minimally invasive surgical procedure. To carry out treatment, the surgeon can enter the abdominal cavity through small (about 5-10 mm) holes using a special instrument - a laparoscope.

The laparoscope resembles a rigid tube equipped with a micro-camera and a light source, and connected to a monitor. Digital matrices in modern models Laparoscopes provide highly accurate images during surgery. Thanks to its clever design, the laparoscope allows you to examine the patient’s abdominal cavity and see on the monitor what is inside it. During a laparoscopic operation, the surgeon controls the surgical field enlarged tens of times. As a result, even minimal pathology is detected (including tiny adhesions in the fallopian tubes).

When comparing laparoscopy with conventional surgery, this type of intervention has obvious “advantages”, consisting of:

• minimal trauma, which reduces the risk of adhesive disease and speeds up recovery after surgery;
• minimal risk of postoperative wound infection;
• Possibility of detailed examination abdominal cavity;
• no need for rough sutures at the incision sites;
• minimal blood loss;
• short period of hospitalization.

Laparoscopic surgery can be used for both diagnosis and treatment. Laparoscopy is much safer than conventional operations and much easier to accept by patients.

However, laparoscopy cannot do without traditional operating attributes in the form of anesthesia, incisions and the use of surgical instruments, which can sometimes lead to various complications.

Despite its apparent simplicity, laparoscopic interventions have some features and limitations. These “buts” include nuances related to:

• possible only with the use of special professional equipment and a fully equipped operating room;
• the huge role of the human factor: only a specially trained professional surgeon has the right to perform laparoscopy.

Indications for laparoscopy in gynecology

Laparoscopic surgeries are most often performed on the abdominal or pelvic area. Using a similar technique, operations such as cholecystectomy (removal of stones from the gallbladder), gastrectomy (removal of part or all of the stomach), hernioplasty (hernia repair), and intestinal surgery are performed.

Laparoscopy is especially often used for diagnosis or treatment in gynecology. This type of minimally invasive intervention is used in almost 90% of gynecological operations.

Laparoscopy often allows women who have long said goodbye to the hope of motherhood to become happy mothers.

Indications for laparoscopy most often include cases of diagnosis or treatment:

• emergency gynecological conditions(cyst rupture, obstruction or ectopic pregnancy, etc.);
• chronic pelvic pain;
• adhesive disease;
• myomatous uterine lesions;
• abnormalities of the uterus;
• endometriosis;
• ovarian pathologies (including cysts, apoplexy, sclerocystosis or);
• torsion of the cyst or the ovary itself;
• tubal ligations;
• tumor neoplasms (including cysts);
• infertility of unknown etiology and ineffective hormonal therapy;
• before IVF;
• conduction or ovaries;
• monitoring treatment results.

The need to use laparoscopy for diagnosis and recovery women's health is also fully justified by the fact that this method maximally corresponds to the principle of organ-preserving operations, allowing a woman to subsequently become a mother.

Endosurgical complications in gynecology

Much less frequently than normal operations, laparoscopy can also sometimes have unintended consequences, health threatening, or even the patient’s life. IN different countries complications after such interventions are taken into account and assessed differently. For example, in the United States, a patient’s stay in the hospital after an intervention for more than one day is considered a complication.

German doctors only keep records of cases related to injuries or damage during laparoscopy (intestines, Bladder or intestines). And French doctors divide complications into minor, major and potentially fatal. IN Lately The concern of some Western scientists is the fact of an increase in urological complications after laparoscopic interventions in gynecology.

Contraindications to laparoscopy

Like any operation, laparoscopy also has its contraindications. They are divided into absolute and relative.

Absolute contraindications for laparoscopy in gynecology are the following cases:

• state of coma or shock;
• severe cardiopulmonary pathologies;
• severe exhaustion of the body;
• bleeding disorders that cannot be corrected;
• severe bronchial asthma or hypertension;
• acute renal and hepatic failure;
• malignant tumors of the ovaries or fallopian tubes;
• the impossibility of giving the patient the Trendelenburg position (tilting the operating table with the head end down): in case of brain injuries, the presence esophageal openings or sliding diaphragmatic hernias;
• hernias (diaphragm, anterior abdominal wall, white line of the abdomen).

Relative (that is, situational and valid until these health problems are eliminated) contraindications to laparoscopy are health problems in the form of:

• pregnancy more than 16 weeks;
• diffuse peritonitis;
• polyvalent allergy;
• complex adhesive process in the pelvis;
• ovarian tumors more than 14 cm in diameter;
• fibroids for more than 16 weeks;
• pronounced abnormalities in blood and urine tests;
• ARVI (and at least a month after it).

What is included in preparation for laparoscopy?

From proper preparation The positive outcome of the operation largely depends on laparoscopy.

Laparoscopy can be performed electively or urgently. At in case of emergency there is no time and opportunity to fully prepare for the intervention. IN similar situations It's more important to save a woman's life.

Before planned laparoscopy, the following studies are required:

• blood (biochemical, general, coagulability, Rh factor, glucose, dangerous diseases(syphilis, hepatitis, HIV);
• urine (general analysis);
• vaginal smear;
• fluorography;
• gynecological ultrasound.

Before the intervention, a therapist’s opinion on the possibility of using anesthesia is also taken. The anesthesiologist asks the patient about allergies and tolerance to anesthesia. If necessary, light tranquilizers can be used before the intervention.

Typically, before laparoscopic surgery, the patient should not eat for about 6-12 hours.

The essence of laparoscopy

After laparoscopy, patients are usually discharged on the same day as the operation or the next.

After general anesthesia, the surgeon makes small incisions (about 2-3 cm) near the navel. Carbon dioxide gas is then injected into the abdomen using a Veress needle.

The gas improves viewing of organs and frees up space for therapeutic procedures.

A laparoscope is inserted into the abdominal cavity through an incision. Images of internal organs are visible to the surgeon through a projection on the monitor.

In addition to the laparoscope, other surgical instruments can be inserted into the incisions. Also, an additional manipulator can be inserted into the vagina to move the uterus in the required direction. After laparoscopy is completed, gas is released from the abdominal cavity, and then stitches and bandages are applied.

Features of the postoperative period

After surgery, patients often experience soreness in the incision area, nausea or vomiting, and a sore throat from using the endotracheal anesthesia tube. However, such phenomena pass quite quickly.

Other symptoms that patients may experience after laparoscopy include bloating or pain in the abdomen, as well as pain in the shoulders for 1-7 days. In this case, painkillers are usually prescribed.

Often women in the first days after laparoscopy have bloody vaginal discharge. Soon this phenomenon passes.

Recovery from laparoscopy usually takes about 5-7 days.

Causes of complications after laparoscopy

Although laparoscopy is the most safe methods surgical interventions, but any operation has its own risk factors. For the successful completion of laparoscopy, many important factors must “grow together”, because there are simply no trifles in surgery.

One of the main conditions for the success of laparoscopic operations is the high skill of the surgeon.

Foreign scientists have calculated that in order to obtain high qualifications in the field of laparoscopic surgery, a specialist needs serious laparoscopic practice. To do this, the surgeon must perform at least 4-5 laparoscopies per week over a period of 5-7 years.

Let's consider what are the causes of possible complications during laparoscopy. Most often, such troubles can occur in the following cases:

1. Violations by the patient of medical recommendations before or after surgery.
2. Medical violations (for example, rules for sanitation of the abdominal cavity).
3. Accessions inflammatory processes.
4. Problems associated with the administration of anesthesia.

Laparoscopic operations are considered difficult due to the lack of ability to control the condition of internal organs (as happens in open operations) and many manipulations are performed “blindly”.

The main factors contributing to the occurrence of complications are:

1. Technological complexity of the operation. If at the time of intervention at least one device from the optical system fails, this is fraught with incorrect actions by the surgeon. Often, when equipment breaks down, it is necessary to switch to open operations.
2. Narrowing of the field of view when using a laparoscope, which does not allow you to see what is happening outside the device.
3. The inability to use tactile sensations, by which the surgeon distinguishes pathologically altered tissues.
4. Errors in visual perception due to the difficulty of transitioning from conventional three-dimensional vision to two-dimensional (through the eyepiece of a laparoscope).

Main types of complications and their causes

Compared to conventional operations, laparoscopic operations have milder and less common complications.

Let's look at the main complications that can happen after laparoscopy.

Complications of the respiratory and cardiovascular systems

Such complications may be associated with:

• limited lung movements due to artificially created diaphragmatic pressure and depression of the central nervous system;
• negative effects of carbon dioxide on the myocardium and pressure levels;
• respiratory depression due to worsening movement of the diaphragm due to its overextension at the time of surgery;
• decreased venous circulation due to accumulation of blood in the veins of the pelvis and lower extremities;
• ischemia of the abdominal cavity and a decrease in pulmonary volume due to artificial compression of the mediastinum;
• negative influence of the patient’s forced position.

Such violations during laparoscopy can lead to serious complications such as pneumonia, the risk of heart attack or respiratory arrest.

It is also possible to develop pneumo- or hydrothorax due to the penetration of gas or liquid into the lungs through diaphragmatic defects.

Prevention

Preventing cardiopulmonary disorders is the task of resuscitators and anesthesiologists. At the time of surgery and immediately after it, blood pressure, blood gases, pulse and cardiac cardiogram should be monitored. Although carbon dioxide reduces the risk of organ injury, but it can affect blood pressure. Therefore, the “cores” use the most low level carbon dioxide pressure.

If the operation lasted more than 1 hour, a chest x-ray is often performed to rule out and identify pulmonary complications.

Thrombotic complications

The formation of blood clots is associated with bleeding disorders (thrombophlebitis, phlebothrombosis) in the pelvis and lower extremities. Especially dangerous pathology is pulmonary embolism.

Elderly women and patients with cardiovascular pathology(with heart defects, hypertension, atherosclerosis, obesity, varicose veins, suffered heart attacks).

Such complications are associated with the following predisposing factors:

• position on the patient’s operating table (with the head end raised);
• duration of the operation;
• artificial increase in intra-abdominal pressure due to pumping gas into the abdominal cavity (pneumoperitoneum).

Prevention

To prevent these complications, methods are used:

1. Administration of heparin (an anticoagulant drug) 5000 units every 12 hours after the end of the operation (or fraxiparin once a day).
2. Overlays elastic bandage on the lower extremities before and after surgery or another type of pneumocompression of the legs at the time of surgery.

Complications associated with the creation of pneumoperitoneum during laparoscopy

Pneumoperitoneum is the introduction of gas into the abdominal cavity (artificial creation of collapse). This is necessary for laparoscopy, but can pose a threat to the patient. As a result, both the gas itself and the mechanical damage organs upon its administration. The consequences of these violations may include:

• Gas entering subcutaneous tissue, omentum or ligament of the patient's liver. (This is easily removable and does not pose a particular health threat).
• Gas entering venous system(gas embolism). This is a dangerous condition that requires immediate medical attention. When a gas embolism occurs, the following methods are used:

1. Stop the gas injection and introduce oxygen.
2. Urgently turn the patient onto his left side with raising the foot end of the table.
3. Aspiration and resuscitation measures to remove gas.

Mechanical damage to blood vessels and organs, burns during laparoscopy

Damage to blood vessels can occur during this operation no more than 2% of cases. This is due to the fact that periodically the surgeon is forced to insert instruments into the body cavity “blindly”.

Internal organ burns are associated with minimal vision surgical field. Defects in instruments also contribute to this. An undetected burn can result in tissue necrosis or peritonitis.

Vascular injuries can vary in complexity. For example, damage to the vessels of the anterior abdominal wall does not threaten the patient’s life, but can subsequently lead to hematomas with the risk of suppuration. But injuries to large vessels (vena cava, aorta, iliac arteries etc.) is very serious and requires acceptance urgent measures to save lives. Vessels can be injured when surgical instruments are inserted (scalpel, trocar, Veress needle, etc.)

Prevention

Injuries to the great vessels can lead to the death of the patient. Therefore, there are a number of measures to reduce the risk of such complications and include:

1. examination of the abdominal cavity before laparoscopy;
2. use of open laparoscopy (without gas injection) for all difficult cases;
3. compliance with safety rules during electrocoagulation of blood vessels, checking the electrical insulation of instruments;
4. transition to open surgery and the involvement of specialists to eliminate the problem (resuscitator, vascular surgeon, etc.);
5. using special protective caps for stylets, a blunt core for a Veress needle, and conducting special tests before inserting instruments.

Other complications after laparoscopy

In addition to the above typical complications, occasionally complications occur with this procedure, the percentage of which is low:

• Suppuration around the trocar wound. May occur due to violation of asepsis at the time of surgery, low immunity and the behavior of the patient himself. Sometimes patients themselves violate doctor’s instructions on the first day after surgery.

To prevent such complications, it is important to comply bed rest and careful handling of the catheter in the wound, preventing it from falling out. If the catheter falls out, there is a high risk of infection around the trocar wound. Compliance with the regimen is important for further normal wound healing.

• Metastasis in the area of ​​the trocar holes. This complication is possible when removing an organ affected cancer cells. Therefore, before laparoscopy, tests are carried out to exclude oncology. Also, during all manipulations during laparoscopy, sealed plastic containers are used to place the removed organ or part thereof. The disadvantage of such containers is their high cost.
• Hernias. Hernias are rare long-term consequences laparoscopy. To prevent this, the surgeon must suture all postoperative openings larger than 1 cm in diameter. Additionally, the doctor uses the mandatory palpation method to identify invisible wounds.

Like no other, laparoscopy cannot be called an intervention guaranteed against all complications. However, an alternative to this gentle intervention is a classic operation, the complications of which are many times higher. If laparoscopy is performed by a highly qualified surgeon and anesthesiologist, according to all the rules, in compliance with a clear operation plan, then complications during this manipulation are reduced to zero. You should not be afraid of laparoscopy, since in any unforeseen circumstances at the time of its implementation, the surgeon can easily correct the situation by moving on to traditional surgery.

Weight that can be lifted after laparoscopy and appendicitis.

Removal of appendicitis is a fairly common operation that will not surprise anyone these days. If similar operations were carried out before surgically using an incision in the lower abdomen, now the intervention can be performed laparoscopically.

Why after laparoscopy, abdominal surgery, appendicitis, hysterectomy you should not lift weights: reasons

As a result of laparoscopy, there is no need to make an incision in the lower abdomen. During the operation, the doctor inserts a probe with a camera into the area of ​​appendicitis or another organ, as well as a special rod that inflates the abdomen and makes the organs inside the abdominal cavity visible.

After the operation, there are no huge scars left, as with abdominal surgery. Three small holes remain, 5-10 mm long. Sometimes doctors don't even put stitches on these types of wounds. The main advantage of this operation is the reduction in rehabilitation time. The point is that everything abdominal operations with incisions, characterized by inflammation of the suture area.

Almost any abdominal surgery is quite dangerous and difficult to tolerate. This is primarily due to the presence of seams. To gain access to the abdominal cavity, the doctor has to cut not only a layer of skin and fat, but also muscle tissue.

Reasons for not lifting weights:

• Violation of the integrity of the skin
• Muscle cuts
• Availability of suture material
• Displacement of internal organs

Often, the sutures after surgery become inflamed, bleed, fester, and the sutures may also come apart. The rehabilitation period primarily depends on the complexity of the operation and its success. One of the most unpleasant operations is to remove the uterus. The point is that after surgical intervention in the traditional manner with an abdominal incision, leaving a long suture. This seam can become inflamed, does not heal for a long time and festers. There are frequent cases of sutures coming apart, so the speed of rehabilitation and recovery depends on following the doctor’s recommendations. In every special case they are individual.

What weight, how many kilograms can you lift after laparoscopy, abdominal surgery, appendicitis, hysterectomy?

First of all, the rehabilitation period depends on the length of the suture and the severity of the surgical intervention. But there are still average boundaries and periods of recovery, as well as general recommendations. With laparoscopy, you can get out of bed in just 3 hours. Very often the patient is discharged home the next day. Because there are no stitches and the pain is quite tolerable. There is no need to take analgesics or painkillers.

Allowable weight:

• With classic abdominal operations with incisions in the abdominal cavity, things are somewhat more complicated. The suture may not heal for a very long time and may not heal well. Therefore, you need to take care of the stitch, follow the doctor’s recommendations, and also take care of yourself.
• During abdominal surgery, whether it is appendicitis or hysterectomy, the patient is discharged from the hospital after about a week. After this, the patient remains on sick leave for 30-45 days and is observed by a local doctor.
• To avoid any complications, other than caring for the seam, it is necessary to follow the recommendations regarding physical labor. Basically, after laparoscopy, you should not lift anything weighing more than 5 kg for about a month. During abdominal surgery, these restrictions may increase for up to six months.
• During these six months, it is necessary not only not to carry heavy objects, but also to limit all physical activity. This applies to sports and running. In the most difficult cases, the maximum rehabilitation period is six months. It is during these six months that you cannot lift more than 5 kg of weight.
• If the scar and suture heal quickly and there are no complications, then these restrictions last for about 2 months. That is, you cannot lift weights weighing more than 5 kg for 2 months.

When and how long after you can lift weights after laparoscopy, abdominal surgery, appendicitis, or hysterectomy?

During the first week or month, during serious abdominal operations, you cannot handle more than 3 kg. Now we are not talking about any specific strength training, but about ordinary purchases. After all, we very often do not control and have no idea how much weight we carry home from the store.

As you can see, the rehabilitation period and level of physical activity are selected by the doctor based on the course of the operation and general forecasts. Try to follow all the doctor’s recommendations and not violate them. This will significantly speed up the healing process.

VIDEO: Rehabilitation period after surgery

Laparoscopy in gynecological practice extremely common. This method has become firmly established in the work of gynecological surgeons due to its low trauma and high efficiency, which does not interfere with the implementation of reproductive plans in the future, which is very important during operations on the pelvic organs.

Fallopian tube laparoscopy is one of the most common gynecological operations. It has many indications, but the majority of patients are women who have difficulty getting pregnant, because infertility has become extremely common lately.

According to statistics, about 40% of all difficulties with conception are caused by female pathology reproductive system, and half of them are due to the fault of the fallopian tubes, which are impassable due to inflammatory processes, infections, consequences of diseases and interventions in the past.

Laparoscopic tubal surgery is performed with both diagnostic and therapeutic purpose, and diagnosis can become a stage of elimination various pathologies, while the patient will not acquire a large scar on the abdominal wall and will quickly recover.

Tubal laparoscopy is an excellent alternative to open laparotomy, allowing the doctor to perform all the necessary manipulations on the pelvic organs, but at the same time it is very low-traumatic, so rehabilitation after it proceeds quickly, and complications are rare. IN modern surgery laparoscopy of the fallopian tubes - the main action for infertility, tumor lesions, adhesive disease, which is widely implemented in clinics in Russia and abroad.

Indications and contraindications for tubal laparoscopy

Reasons for laparoscopic tubal intervention may include:

Infertility - one of the most common reasons leading a woman to laparoscopy. In this case, it is of a diagnostic nature if the cause of infertility is not fully understood, but during the operation, obstacles to pregnancy (adhesions, for example) can also be eliminated, which will simultaneously serve as a treatment for the existing pathology.

Adhesive disease with the development of scar adhesions around the fallopian tubes - another common pathology, the cause of which can be both infectious and inflammatory processes (banal infection, STIs, tuberculosis, chlamydia, cytomegalovirus, etc.), as well as previous abdominal surgeries in this area. In particular, appendectomy contributes to serious reproductive problems due to scarring, so laparoscopy of fallopian tube adhesions is a fairly common procedure for problems with childbearing.

ectopic pregnancy

Ectopic pregnancy, when the zygote attaches and begins to develop outside the uterus, it most often occurs in the tube, from which, for one reason or another, a fertilized egg has not emerged. This pathology is classified as a surgical emergency, because a pregnancy growing in the tube is a direct path to organ rupture and fatal bleeding. With this pathology, laparoscopy is aimed at removing the affected tube along with the embryo.

Some experts propose methods of removing the embryo laparoscopically while preserving the organ, but experience shows that almost all tubes preserved in this way are difficult to pass in the future, and the risk of a repeat tubal pregnancy in them increases significantly. In this regard, most gynecologists insist on the need for complete excision of the tube laparoscopically.

Impaired patency of pipes implies the need diagnostic laparoscopy, during which the doctor determines the etiology of obstruction, its prevalence, and also finds out the possibilities of eliminating the pathology. This laparoscopy can be supplemented with chromotubation when the degree of obstruction is diagnosed using dye. A sterile dye is injected into the uterine cavity, and if the tube is not sclerotic, it exits into the abdominal cavity, which is recorded by the surgeon’s eye.

Laparoscopy for tubal patency is carried out for a variety of pathologies lying outside the lumen of the organ - endometriosis, paratubar cysts, benign tumors. Disturbances in the tubes can be expressed in the accumulation of pus in them (pyosalpinx), serous fluid(hydrosalpinx), which also requires surgical treatment, preferably through laparoscopic technique. Usually, the affected tube is removed entirely during the operation, because it is no longer capable of performing its main function, and there will definitely be no benefit from its presence.

If in case of infertility the main goal of laparoscopy is to achieve pregnancy, then sterilization- the opposite situation. When there are already children, but there is no desire to have more, a woman can decide on a surgical method of contraception. This manipulation is also performed laparoscopically for patients who have reached the age of 35 and have at least two children. The result of laparoscopy will be irreversible, which the doctor must warn you about.

Before prescribing laparoscopic tubal intervention, the gynecologist determines the presence of obstacles, which can be absolute or relative.

Absolute contraindications to tubal laparoscopy are:

It is worth noting that some absolute contraindications may become relative if we'll talk about saving lives. For example, a tubal pregnancy in a woman with blood clotting disorders somehow requires surgery, and in this case, laparoscopy is preferable, because blood loss will be less than with conventional laparotomy.

TO relative obstacles include severe obesity, diabetes, high blood pressure, adhesive disease pronounced degree. For such patients, the possibility of intervention is determined individually based on the possible risk.

Preparation for treatment and anesthesia techniques

Laparoscopy of the fallopian tubes is impossible without proper preparation, the quality of which determines the degree of risk of complications and adverse consequences. Before planned surgical treatment, a woman will have to undergo a comprehensive examination, as well as treat existing diseases, especially chronic ones, as completely as possible.

The main goal of preparation is the prevention of subsequent complications, but the need for anesthesia is very important point throughout the intervention. Anesthesia can not only aggravate chronic disorders of internal organs, but also become absolute contraindication for some diseases.

List necessary examinations before laparoscopic treatment is close to standard before any operation. It includes:

• General clinical blood and urine tests;
• Fluorography;
• Coagulogram;
• Clarification of blood type and Rh factor;
• Infection testing;
• Electrocardiography.

In addition to tests general, an examination by a gynecologist is indicated with sampling of the contents of the genital tract for flora, cytology of the cervix, ultrasonography appendages to clarify the nature and prevalence of changes.

Patients with extragenital diseases(diabetes, pathology thyroid gland, hypertension, bronchial asthma etc.) must consult with relevant specialists to resolve the issue of the safety of the operation and correction of the course of chronic pathology before, during the intervention and in the postoperative period.

At the preparation stage, it is very important to inform your doctor about all medications you are taking, especially those that affect blood clotting. Anticoagulants and antiplatelet agents are discontinued before laparoscopy; other drugs that the patient takes for a long time (hypotensives, for example) are prescribed at required quantity and cannot be cancelled.

When all the examinations have been completed, the woman goes to the therapist, who signs his consent to perform laparoscopy. The physician's permission means that the operation will be safe and the risk of complications is minimal.

All examinations can be completed at your clinic, but it is important that the period from the date of taking the tests is no more than two weeks. If necessary, some studies can be duplicated on the eve of the intervention (coagulogram, for example).

On the appointed day, the patient comes to the clinic, where she is examined by the attending physician, who makes sure that the preoperative preparation is complete. The gynecologist once again explains the essence of the intervention and its necessity, and also obtains written consent for surgery from the woman's side.

An anesthesiologist must come on the day of admission, because anesthesia is an integral and extremely important part of any operation. Laparoscopy of tubes requires general anesthesia, and the anesthesiologist carefully monitors the indicators blood pressure, pulse, blood oxygen saturation, etc., which is why it is so important to inform the doctor about all medications taken, existing diseases, allergies.

Anesthesia can be masked, when anesthetics are administered intravenously, and nitrous oxide is inhaled through a mask, or endotracheal with the maintenance of artificial respiratory ventilation. Endotracheal anesthesia has advantages - opportunity exact dosage toxic medicines for anesthesia and more low risk leakage of gastric contents into the respiratory tract.

On the day before the operation, the patient is limited in food, excluding foods that cause bloating, and in the evening she does not eat or drink at all. Before going to bed, she takes a shower, shaves off the hair from her external genitalia, and changes into clean underwear. An enema is performed to cleanse the intestines and facilitate the application of pneumoperitoneum.

In order to prevent thromboembolic complications, especially in cases of already diagnosed varicose veins or other vascular problems, elastic bandaging of the legs is indicated. The bandages can be removed after laparoscopy, when the doctor considers it safe.

Tubal laparoscopy technique

Tubal laparoscopy is indicated as planned treatment or it is performed urgently in case of life-threatening conditions (bleeding and rupture of the tube during ectopic pregnancy, torsion of the cyst). It is diagnostic and therapeutic.

Diagnostic laparoscopy pursues the goal of accurately establishing the nature of the pathology when other methods of non-surgical examination have not brought the desired result. It makes it possible to determine the cause of infertility and immediately, simultaneously, eliminate it. Therapeutic laparoscopy is prescribed for established diagnosis for liquidation pathological process or is a continuation diagnostic operation. To monitor previous treatment, repeat laparoscopy may be indicated.

Laparoscopy for patency of the fallopian tubes is aimed at removing changes in them that do not necessarily cause infertility, but are dangerous due to their complications - torsion of the cyst or its suppuration, endometriosis. In case of organ obstruction, the main goal is to restore the lumen and the possibility of conception with subsequent intrauterine pregnancy.

Laparoscopic fallopian tube removal indicated when it is impossible or impractical to preserve it - tubal pregnancy, hydro- or pyosalpinx, severe endometriosis. In this case, the tube is cut off from the surrounding tissues, carefully coagulating the vessels, and then removed out through one of the trocar holes. No additional incisions are required to remove the organ.

fallopian tube laparoscopy

Laparoscopy of the fallopian tubes is performed in the operating room with general anesthesia. Usually it takes 20-40 minutes, a maximum of an hour, but in difficult situations it extends to one and a half hours or more.

Before inserting the instruments, the puncture area is treated with antiseptics, and then three trocars are inserted - hollow tubes with a sharp internal rod. Through trocars, a video camera, a light source and the necessary instruments are placed inside the abdomen - forceps, coagulators, clamps, retractors, etc.

To facilitate the surgeon’s actions and create free space, gas (pneumoperitoneum) is injected into the abdomen, elevating abdominal wall. It is supplied through the first puncture in the umbilical area. A video camera is inserted through the second puncture, and instruments are inserted through the third. The surgeon tracks the entire progress of the operation on the screen, while receiving a tenfold magnification of the internal organs.

Using laparoscopic instruments, the surgeon can dissect adhesions and isolate pipes from them to restore their patency, remove tumor-like processes on the pipe or the entire pipe itself if indicated.

Da Vinci system

Modern laparoscopic technology offers a range of automated systems(robots) that facilitate the work of the operator and make laparoscopy more effective. For example, application Da Vinci systems provides a number of advantages:

1. Minimal blood loss and low tissue trauma;
2. Less pain during the recovery period;
3. Virtually zero risk of infectious complications;
4. Fast recovery.

The high-tech equipment of the Da Vinci system allows you to obtain high-quality three-dimensional images of organs; the device itself is controlled by the surgeon. The robot has 4 “arms”, through which laparoscopy is performed. During the intervention, the device performs smooth actions controlled by the doctor, so inaccuracy or trembling of the operator’s hands is eliminated. The Da Vinci system is more functional than trocar instruments; the likelihood of injury to surrounding structures is reduced to zero.

Significant disadvantages of robotic laparoscopy can be considered the high cost of equipment and the need for personnel training, which affects the availability and cost of the operation itself, therefore, without looking at undoubted advantages method, not every hospital and not every patient can afford it.

After completing all necessary actions on the pipes, the surgeon coagulates the vessels, makes sure there is no bleeding, once again examines the intervention area, and then takes the instruments out. The puncture sites are sutured. Drainage is usually not necessary, but in case of purulent processes in the tubes, drainage can be left in the pelvis for the first days of the postoperative period.

Postoperative period and its complications

The postoperative period after laparoscopy of the fallopian tubes is usually easy, because the method of operation itself has a lot of advantages - low trauma, absence of a large incision, speed of execution, minimal risk of complications.

After the operation, the patient is taken to the ward, where, after emerging from anesthesia, she can get up by the evening of the same day. Early activation is the key to successful recovery, so you shouldn’t lie too long in bed; it will even be useful to just walk along the ward or corridor of the hospital. Walking will not only help the tissue heal faster, but will also serve as an excellent prevention of post-operative intestinal problems (constipation), as well as such serious complications, like thrombosis of the leg veins.

Laparoscopy does not require long-term hospitalization, so after 3-4 days the patient goes home, and the sutures are removed by the end of the first week after the intervention. Rehabilitation takes about a week on average, but to resume sex life and the doctor will recommend exercise no earlier than in a month. A couple of weeks is enough for the external sutures to heal and the intestines to function again, but the patient must remember that internal incisions take longer to regenerate, so for the first 3-6 months after the intervention, heavy lifting and heavy physical labor should be limited.

In the first couple of days, a woman may feel pain at the puncture sites, as well as shoulder girdle and abdomen, which is associated with gas injection during laparoscopy. Usually these symptoms go away on their own without leaving any consequences.

Postoperative intestinal paresis is a common occurrence after any operation, which manifests itself in pain, bloating, and constipation. To combat it, physical activity and following a gentle diet that excludes fatty and fried foods, carbonated drinks and foods that increase gas formation (cabbage, legumes, baked goods) are recommended. For several days it is better to eat small meals, preferably light soups, cereals, steamed meat, without loading digestive system large amount of food.

Since interventions on the appendages are often performed due to infertility, women are very concerned about the issue of pregnancy after laparoscopy of the fallopian tubes. It is believed that if the cause of infertility was adhesions on the outside of the tube, then laparoscopy will lead to the restoration of fertility in more than half of those operated on.

The issue of planning pregnancy after laparoscopy must be approached responsibly. The first month is healing internal seams, and in 2-3 months the chances of getting pregnant are maximum, so it is better not to delay conception for a significant period. After six months, the likelihood of pregnancy begins to gradually decrease due to possible education commissures, therefore the first three months is the period recommended by experts for its onset.

If conception has occurred, and a happy woman holds in her hands positive test pregnancy, then you still can’t relax, because the risk of ectopic fetal development after laparoscopy increases, especially if the operation was performed for obstruction of tubes or adhesions. In this regard, you should carefully monitor your well-being, immediately go to a consultation and regularly undergo all recommended examinations.

Complications after laparoscopy are rare, although possible. These include bleeding, damage neighboring organs, purulent-inflammatory processes. The consequences of the operation can be a repeat ectopic pregnancy and adhesions in the pelvis, further reducing the likelihood of childbearing in the future.

Laparoscopy is an operation whose purpose is to diagnose a disease or surgically treat it. Basic distinctive feature The laparoscopic method is minimal damage to external tissues. Manipulations on organs are performed through small incisions, and control is carried out using a laparoscope equipped with a tiny video camera.

The operating surgeon evaluates in detail the image of the internal organs displayed on the monitor. Despite the minimally invasive method, it belongs to surgical interventions. Therefore, preliminary preparation, diet and rules of nutrition after laparoscopy must be strictly observed. Features of the postoperative diet depend on the area of ​​the body where laparoscopy was performed.

About intervention

Progressive surgical technique used for examination and operations on the abdominal organs, female internal genital organs (in gynecology), in the field of thoracic surgery (diagnosis and operations on the chest organs). The most widely used types of laparoscopic interventions are:

• excision of the gallbladder (cholecystectomy);
• removal of appendicitis (appendectomy);
• resection of the stomach or its (gastrectomy);
• laparoscopic operations on the ureter and bladder;
• fragmentary excision of the pancreas, duodenum (Whipple operation or pancreaticoduodenectomy)
• resection of a fragment of the small and large intestine;
• laparoscopy of the lung.

In gynecology, similar operations are performed to remove ovarian cysts, in case of pathology of the fallopian tubes and uterus. All types of operations are performed after a thorough examination, including: lab tests blood (clinical and biochemical), hardware diagnostics (ultrasound, magnetic resonance and CT scan, x-ray examination).

The patient must follow a diet and, in some cases, take certain medications, which the doctor will tell you about.

Certain rules are provided for in the period after surgery, most of them relate to diet and physical activity. Compliance with the conditions helps to quickly restore body functions after surgery.

The need for a dietary diet in the postoperative period

First of all, proper nutrition requires an optimal balance of nutrients (fats, carbohydrates, proteins). This, in turn, ensures the normal functioning of organs gastrointestinal tract. The patient does not experience dyspepsia (difficult and painful digestion) or flatulence. There are no problems with bowel movements (diarrhea, constipation).

The postoperative diet consists of the so-called healthy foods. The use of which helps strengthen the immune forces of a weakened body. The sutures, even small ones, are tightened faster, and the risk of adverse postoperative complications is extremely limited. In addition, such products accelerate the elimination of toxic substances accumulated under the influence of anesthesia, facilitating the functioning of the liver.

The diet promotes the regeneration of the body's hormonal and reproductive systems. Especially in cases where laparoscopic surgery in the field of gynecology was performed. If you have difficulty creating a menu on your own, you should seek help from a nutritionist.

General conditions for proper nutrition

The diet after laparoscopic surgery takes into account chemical composition And physical properties products, as well as the culinary method of processing dishes and the time range between meals.

Key points for healthy post-operative nutrition:

• The initial meal after laparoscopic surgery must be agreed with the doctor. If there is no nausea from anesthesia, it is resolved after six hours. chicken bouillon(fat skin is removed from poultry before cooking);
• food should be warm, but in no case hot. Aggressive influence is not allowed high temperatures on the digestive system;
• The interval between meals is determined by two and a half hours. The serving size is no more than 300 grams; it is unacceptable to be greedy in food;
• preference is given to products enriched minerals and vitamins, without disturbing the balance of nutrients;
• herbal infusions are welcome;
• culinary processing of products by frying is excluded. You can only eat dishes that are prepared by stewing, boiling, or baking without oil (other fat);
• in the first postoperative days the best option will grind the food with a blender to a puree state. In this form, food will be easier to digest;
• The diet should not change in a forced mode. Products are introduced in stages, from light to more difficult to digest;
• At the stage of introducing fresh fruits and vegetables, you should not eat hard skins.

This advice is used in most cases where dietary adjustments are necessary.

The diet cannot be stopped after discharge from the hospital. Throughout the month, the risk of complications due to overeating or consumption of prohibited foods remains. There is a complete taboo on any alcohol during the postoperative period.

Products to be excluded from the diet

The average duration of the diet after laparoscopy is four weeks. Next, you can navigate according to your own well-being. What not to eat:

• animal fats: butter, lard and fresh lard;
• fish and meat prepared by hot or cold smoking;
• fatty mayonnaise-based sauces and ketchups;
• canned foods (fish, meat, vegetables);
• salted and pickled mushrooms and vegetables;
• whole grain baked goods, including bread;
• baked goods, sweet desserts;
• peas, chickpeas, beans, lentils;
• raw vegetables;
• strong fruits (pears, apples) and citrus fruits;
• carbonated drinks, yeast-containing kvass;
• nuts;
• fast food;
• seasonings, spices.

Sausages, fatty cottage cheese and milk, and dried fruits are subject to restrictions. A failure in diet can result in postoperative complications. In patients who ate prohibited foods, suture dehiscence was observed due to difficulty in bowel movement.

Products prohibited during the postoperative period

When correcting the diet, the main emphasis is on light foods rich in vitamins and microelements. What can you eat after laparoscopy: porridge with water or low-fat milk of a liquid consistency, steamed, boiled or vegetable stew: carrots, zucchini, beets, liquid mashed potatoes, broths and lungs vegetable soups, low-fat fish (pollock, haddock, hake), which are steamed.

The list continues with boiled turkey or chicken ( steam cutlets from poultry meat), beef liver, processed by stewing, soft cottage cheese, yogurt, fermented baked milk, kefir (fat content is observed fermented milk products at 2.5%), fruit and oat jelly. Also recommended are any seafood, peeled fruits, berries, omelette cooked in microwave oven, compotes homemade, diluted freshly squeezed juices.

Nutrition requires special attention after removal of appendicitis and operations on gallbladder, since these organs are directly related to the digestive system. Daily diet after laparoscopy:

• first day. After recovery from anesthesia, only table water without gas is allowed in small portions. In the absence of a gag reflex and a feeling of nausea, after 6 hours you can drink weak chicken broth;
• second day. It is optimal to start your meal with low-fat yogurt (you can drink it). You can add vermicelli or noodles to the broth;
• the next 2–3 days involve the introduction of liquid mashed potatoes without oil, boiled fish, chopped boiled chicken in broth, porridge in water, soft cottage cheese, fruit puree;
• on days 4-5, the diet should be enriched with steamed or stewed vegetables. A little marshmallow and baked apples are allowed.

At the end of the week, the operated patient can switch to good nutrition products from the recommended list of acceptable ones. To normalize the bowel movement process daily use We recommend boiled beets with prunes chopped in a blender. This salad should be topped with natural yogurt.

An example of a gentle menu in the second postoperative week

Breakfast : rolled oats porridge on water based or milk, fat content 1.5%.

Lunch: fruit puree.

Lunch: chicken soup with noodles and pureed chicken, stewed vegetables, fruit drink or juice.

Afternoon snack: decoction of medicinal herbs, Lenten cookies(biscuits).

Dinner: steamed fish, liquid mashed potatoes (low-fat milk is used, no butter is added), weak green tea.

At night – 200–250 ml of kefir 1% fat. Kefir must be fresh (daily). Over the next two weeks, all products from the permitted list are introduced sequentially. After about a month and a half, the patient returns to the preoperative diet.

During the rehabilitation period, sports and other physical activities should be limited, and excluded in the first two weeks. It is unacceptable to lift heavy objects. In the same time, complete absence motor activity may lead to the formation of adhesions. The operated patient is recommended to undergo daily therapeutic walking. Speed ​​and distance are determined individually, based on how you feel.

Laparoscopic operations rarely lead to complications. The rehabilitation process takes less time than after conventional strip surgery. This is one of the advantages of this surgical method. Other prerogatives include:

• decrease possible damage organs adjacent to the one that is subject to surgery. They are not involved in the process:
• reducing the risk of infection. Through small incisions it is more difficult for infection to enter the body;
• scanty probability of adhesions;
• aesthetic appearance of the body.

Proper nutrition will help speed up the body's recovery. The main thing is not to ignore the recommendations of your doctor.