Complications after surgery. Postoperative period

Deciding on a surgical operation, each person hopes for a successful outcome. Of course, much depends on modern technologies and the skill of the surgeon. “But the results of even the most successful operation can be nullified if it is not accompanied by competent and timely rehabilitation,” says anesthesiologist, resuscitator Sergey Vladimirovich DANILCHENKO. Among the problems that lie in wait for surgical patients after a planned operation (especially for oncological diseases and operations on the lungs and heart), doctors identify the following.

Any surgical intervention (especially associated with large blood loss) causes a physiological protective reaction: the body seeks to increase blood clotting in order to reduce blood loss. But at some point, this defensive reaction can become pathological. In addition, due to prolonged bed rest, the rate of blood flow in the veins decreases. As a result, blood clots form in large vessels (in the veins of the lower leg, iliac, femoral, popliteal), which, breaking away from the walls of the vessels, can enter the pulmonary artery with the blood flow and lead to acute respiratory, heart failure, and eventually to death.

HOW TO WARN.

If you are at risk due to the development of thromboembolism (during the operation there was a large blood loss, you have thick blood, there are problems with blood vessels in the anamnesis), the doctor, having studied the clinical picture, may recommend taking anticoagulants. These drugs reduce blood clotting, which means they prevent the appearance of blood clots. They must be taken in strictly defined doses and for as long as the doctor says - this is important for restoring health. Also, to prevent such a serious complication, all patients are shown wearing compression stockings - within a month after the operation. This item of clothing must be present daily! At night, tights can be removed (elastic bandages are less preferable, since it is difficult to achieve the desired degree of compression by bandaging the legs with them). The third rule that will help to avoid congestion in the vessels is physical activity. If possible, with the permission of the doctor, it is desirable to “stand on your feet” as soon as possible. The load must be controlled (with the help of the attending physician and the exercise therapy doctor), so as not to overdo it and not overstrain the body weakened after the operation. Compliance with all the rules will help minimize the occurrence of thromboembolism.

Prolonged stay in a horizontal position leads to the fact that zones appear in the lungs that are poorly supplied with oxygen. As a result, favorable conditions are created for the development of the inflammatory process, which can lead to hypostatic (congestive) pneumonia. Postoperative pneumonia is especially dangerous for the elderly - often it is severe and can lead to sad consequences.

HOW TO WARN.

As soon as a person comes to his senses, you need to start breathing exercises (even if he is in intensive care). This is done by exercise therapy instructors who are part of a specialized rehabilitation team. The patient himself, to the best of his ability, should do the breathing exercises that he will be prescribed. Under their influence, the respiratory muscles are strengthened, the mobility of the chest increases. Breathing becomes less frequent and deeper, vital capacity and maximum ventilation of the lungs are restored - all this is the best prevention of inflammatory diseases of the bronchi and lungs. When the patient is transferred to the ward, with the permission of the doctor, it is necessary to do a light vibration massage for 10-15 minutes a day, preferably in the morning (stroking, rubbing, tapping with the edge of the palm, clapping with palms folded in the shape of a boat). Such exercises help cleanse the lungs, improve blood circulation, and besides, contact with a loved one has a general beneficial effect, calms the patient and distracts from the experiences associated with the operation.

Such a problem is possible after abdominal surgery, when surgical intervention can lead to a subsequent divergence of muscle tissue at the site of a recent incision and the exit of the organs of the gastrointestinal tract (often the intestines) outside the peritoneum.

HOW TO WARN.

If you have undergone an operation on the anterior abdominal wall, wear a special elastic bandage for two months. Do not lift more than two kilograms. Avoid sharp bends, body turns to the side. Treat colds in time, especially if there is a tendency to bronchopulmonary diseases with a strong cough. Stop smoking - this is the main provocateur of coughing fits. Eat vegetables, herbs, fruits. The fiber contained in them will prevent constipation (strong straining for 2-3 months is dangerous for the appearance of a hernia), in addition, the predominance of plant foods in the diet guarantees a stable weight, and this contributes to faster tissue healing. As soon as the doctor allows you to increase physical activity, begin to strengthen the muscle corset. For the prevention of cicatricial hernia, exercises “” are useful - it trains the muscles of the back, oblique and rectus abdominal muscles, “Corner” (you hang on the horizontal bar and hold your legs at a right angle), “Legs on weight” (lie on the mat, hands behind your head, and keep your legs at a 45 degree angle). As well as the famous "Bicycle". Be consistent. Avoid sharp, incommensurable physical exertion with your strength.

With prolonged immobility (often after abdominal operations on the heart, oncological operations), muscle weakness develops, the supply of organs and tissues with nerves is disturbed, which ensures their connection with the central nervous system (muscle innervation). Because of this, the patient cannot raise his arms or legs, or even breathe fully.

HOW TO WARN.

Rehabilitation of such patients begins in the intensive care unit as soon as the condition stabilizes. The specialists of the rehabilitation team, which includes a neurologist, physical therapy instructors, and a speech therapist, begin their work. However, rehabilitation measures should be performed if the patient is in a state of medical sleep and on mechanical ventilation. First of all, it is passive gymnastics (flexion-extension, massage of arms, legs). As the patient regains strength, with the permission of the doctor, the patient must begin to sit in a bedside chair, this helps to increase the tone of the muscles of the body, as well as improve pulmonary ventilation. Next, the stage of restoring walking skills begins with the use of walkers and canes. Then follow the elements of active gymnastics. The level and volume of the load are determined by the head of the rehabilitation group and the exercise therapy instructor, taking into account the individual capabilities and condition of the patient. A lot depends on the moral and physical support of relatives, who should try to inspire the patient, show their maximum interest in restoring his health. It is important to remember that only if the recommended loads are observed, muscle atrophy gradually disappears.

These complications develop in almost all patients who are on artificial lung ventilation for a long time, which is carried out either through a tracheostomy or through an endotracheal tube. As a result, not only speech can be disturbed, but also the act of swallowing, due to which part of the food enters the respiratory tract, and this is fraught with aspiration of the lungs.

HOW TO WARN.

In most cases, the function of swallowing, as one of the most important biological functions, is usually restored. However, in the first 2-3 weeks after the operation, the following rules should be strictly observed:

eating only in an upright position with a slightly tilted head forward.

food should be chopped, not dry and without large fragments.

liquid is best given to drink from a straw. By the way, a liquid with a pleasant taste restores swallowing skills faster and is swallowed better than ordinary water.

it is necessary to feed a person only in a state of full wakefulness (not sleepy, not lethargic).

no need to force to eat everything cooked, appetite is restored gradually, forcible eating can lead to the fact that a person chokes.

Also, a speech therapist must deal with the patient. With the help of special exercises, a speech therapist not only restores the patient's speech, but also the normal act of swallowing. The sooner rehabilitation measures begin, the faster the recovery of lost skills comes and the better the results of treatment will be.

These are seals from the connective tissue that appear after surgery. So the body tries to “fence off” the damaged area (inflammatory process), “gluing” the tissues and preventing the infection from spreading to other organs. Most often, adhesions are caused by operations on the pelvic organs, whether it is an abortion, curettage after a miscarriage or polyps, a caesarean section, or the installation of an intrauterine device. In this regard, abdominal surgery is the most dangerous, since it has the greatest traumatic effect.

HOW TO WARN.

After the operation, you will be prescribed a course of antibiotics, which must be completed! It is impossible to allow infectious agents to remain in the uterus or tubes, adapt to the internal environment and begin to multiply! Often, it is the negligent attitude to antibiotic therapy that causes the formation of adhesions. After the intervention, as soon as the doctor allows, it is necessary to get out of bed, take short walks. Movement improves blood circulation, prevents the appearance of adhesions. For prevention, preparations based on hyaluronidase are also used, they have a resolving effect. Hirudotherapy has proven itself well. Leech saliva normalizes the blood supply to tissues and organs.

And special enzymes thin the blood well and have a destructive effect on fibrin, which is the basis of adhesions. After 2-3 weeks, the doctor may recommend physiotherapy. Among the most common methods are: ozocerite and paraffin applications on the abdomen. Due to the warming effect, they contribute to the resorption of adhesions. Well helps and electrophoresis with calcium, magnesium and zinc.

Doctors consider the ability to serve oneself (eat, take a shower, go to the toilet) as the criterion for successful rehabilitation after surgery.

These skills should return within the first week (the information is general, since much depends on the complexity of the operation and the age of the patient). The next stage of rehabilitation (ideally) should be a transfer to either a sanatorium or a rehabilitation center. If you are shown spa treatment - do not refuse. This is a good way to relax after surgery and fully recuperate.

- Early - as a rule, develop in the first 7 days after surgery;

- Late - develop through various periods after discharge from the hospital

From the side of the wound:

1. Bleeding from a wound

2. Suppuration of the wound

3. Eventration

4. Postoperative hernia

5. Ligature fistulas

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

- Failure of the anastomosis sutures (stomach, intestine, 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 CCC - acute coronary insufficiency, myocardial infarction, thrombosis and thrombophlebitis, pulmonary embolism;

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

- Acute renal and hepatic failure.

- Pneumonia.

Postoperative complications can be represented as a diagram

Care begins immediately after the end of the operation. If the operation was performed under anesthesia, the anesthesiologist gives permission for transportation. With local anesthesia - the patient is moved to a stretcher after the operation, either independently or with the help of staff, after which he is transported to the postoperative ward or to the ward in the surgical department.

sick bed should be prepared by the time he arrives from the operating room: covered with fresh linen, heated with heating pads, there should be no wrinkles on the sheets. The nurse should know in what position the patient should be after the operation. Patients usually lie on their backs. Sometimes, after surgery on the organs of the abdominal and thoracic cavities, patients lie in the Fowler position (semi-sitting position on the back with limbs bent at the knee joints).

Patients operated on under anesthesia are transported to the intensive care unit (intensive care) on the bed of the same unit. Transferring from the operating table to the functional bed is carried out under the supervision of an anesthesiologist. The unconscious patient is carefully lifted from the operating table and transferred to the bed, while avoiding sharp flexion of the spine (dislocation of the vertebrae is possible) and hanging of the limbs (dislocations are possible). 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 transportation, there may be signs of impaired breathing and cardiac activity, therefore, the escort of the anesthesiologist and the anesthetist nurse 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 must be able to use an electric suction to help the patient with vomiting). Covered with a warm blanket.

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

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

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 the hips and knees are raised to reduce blood stasis 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 operations on the abdominal organs, after they regain consciousness, are laid in bed with their heads slightly raised and legs slightly bent at the knees and hip joints.

Prolonged stay of the patient in bed is not desirable, due to the high risk of complications caused by physical inactivity. Therefore, all factors that deprive him of mobility (drainages, 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 that determine the timing of the patient's getting out of bed. Most patients are allowed to get up 2-3 days after surgery, but the introduction of modern technologies in medical practice changes a lot. After laparoscopic cholecystectomy, it is 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 the operation, it is necessary to teach the patient the rules of getting out of bed. In the evening or the next morning, the patient should already sit on the edge of the bed, clear his throat, move his legs, while in bed he should change his position as often as possible, make active movements with his legs. At the beginning, the patient is turned on his side, to the side of the wound, with bent hips and knees, while the knees are on the edge of the bed; the doctor or nurse helps the patient to sit up. Then, after taking a few 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 be activated in accordance with his own feelings and the doctor's instructions.

Sitting in bed or chair is not recommended because of the risk of slowing down venous blood flow and the occurrence of thrombosis in the deep veins of the lower extremities, which in turn can cause sudden death due to thrombus separation and pulmonary embolism.

For the timely detection of this complication, it is necessary to measure the circumference of the limb daily, palpate the calf muscles in the projection of the neurovascular bundle. The appearance of signs of deep vein thrombosis (edema, cyanosis of the skin, an increase in the volume of the limb) is an indication for special diagnostic methods (ultrasound dopplerography, phlebography). Especially often, deep vein thrombosis occurs after traumatological and orthopedic operations, as well as in patients with obesity, oncological diseases, and diabetes mellitus. Reducing the risk of thrombosis in the postoperative period is facilitated by the restoration of disturbed water and electrolyte metabolism, the prophylactic use of direct-acting anticoagulants (heparin and its derivatives), early activation of the patient, bandaging the lower extremities with elastic bandages before surgery and in the first 10-12 days after it.

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Ministry of Education, Youth and Sports of Ukraine

National University of Physical Education and Sports of Ukraine

Essay

On the topic of: « Causes of complications after surgery»

Prepared

Orlov Anton

Group 5.06

Introduction

1. Complications after surgery

2. Five classes of postoperative complications

Bibliography

Introduction

After surgery for endometriosis, as after any other surgical interventions, there can be various complications. Most of them pass quickly and are easily treated. The tips we provide below are general information. If you notice any unusual symptoms, deterioration of health, then tell your doctor about it. Also, be sure to tell your doctor if you have any bleeding, fever, swelling, or discharge from the postoperative wound.

1. Complicationsle surgery

Constipation is a fairly common complication of abdominal operations, especially if they are performed on the intestines. If this complication occurs, your doctor may prescribe laxatives for you. What can help prevent constipation after surgery? First, eat more fiber foods. the fact is that dietary fiber irritates the intestinal wall and stimulates intestinal motility (that is, the work of the intestine). Secondly, drink more water, up to seven glasses a day is recommended. Third, take small walks daily. Early activation promotes better breathing, and the diaphragm - the main respiratory muscle - has a “massaging” effect on the intestines.

Diarrhea is also a fairly common complication that occurs after abdominal operations, especially if they are performed on the intestines. If you have severe diarrhea or it is accompanied by fever, you should tell your doctor. Your doctor may prescribe medicine for diarrhea. In addition, diarrhea can be a manifestation of an infection in the intestines. In this case, antibiotics are usually prescribed. But in no case do not start taking any medications on your own without consulting your doctor. At home, you can prevent diarrhea with ginger tea or chamomile tea, and limit your intake of dairy products, carbonated drinks, and caffeine.

Shoulder pain. During laparoscopy, carbon dioxide is injected into the abdominal cavity. Gradually it dissolves. However, after the operation, the gas rises to the diaphragm, on the lower surface of which the nerves are located. Irritation of these nerves with gas leads to unpleasant pain sensations that radiate to the shoulders. In this case, pain can be relieved by thermal procedures: heating pads can be placed in front and behind the shoulder. In addition, your doctor may prescribe pain medication for you. In order for carbon dioxide to be absorbed faster, mint or ginger tea, as well as carrot juice, are recommended.

Bladder irritation. Usually, during and after surgery, a catheter is inserted into the patient's bladder - a flexible plastic tube through which urine flows. This is to control urination during and after surgery. In addition, very often in the postoperative period, urinary retention may occur. This is a reflex phenomenon. Over time, it passes. However, the catheter itself can irritate the mucous membrane of the urethra, causing inflammation - urethritis. It is manifested by moderate pain and burning in the urethra during urination. To prevent this complication, it is recommended to drink plenty of fluids in the postoperative period, as well as personal hygiene. If you feel pain and cramps when urinating, as well as a change in the color of urine (urine becomes dark or pinkish), urination has become frequent, you should consult a doctor. These signs may indicate an infection in the bladder - cystitis. Antibiotics are usually prescribed for cystitis. Your doctor may prescribe painkillers to relieve pain. In addition, a plentiful warm drink is recommended, preferably rosehip decoctions. It is even better to drink cranberry juice, as cranberries have natural antiseptics that suppress the infection.

Thrombophlebitis and phlebitis. Phlebitis is an inflammation of the wall of a vein. Thrombophlebitis is a condition in which inflammation of a vein is accompanied by the formation of a blood clot on its wall - a thrombus. usually after surgery, phlebitis / thrombophlebitis can occur due to a long stay in the vein of an intravenous catheter. The situation is aggravated by the introduction of certain drugs into the vein that irritate the vein wall. Phlebitis / thrombophlebitis is manifested by redness, swelling and pain along the inflamed vein. If there is a thrombus along the vein, you can feel a small seal. If you experience these symptoms, you should immediately inform your doctor. With the development of phlebitis, heat compresses, painkillers and anti-inflammatory drugs are usually prescribed. In addition to compresses, anti-inflammatory ointments (for example, diclofenac) can be used. With the development of thrombophlebitis, heparin ointment is usually used. Heparin, when applied locally, is absorbed into the affected vein. However, heparin itself does not resolve the thrombus. It only warns its further development. The thrombus dissolves itself in the course of treatment.

Nausea and vomiting are very common after any operation performed under general anesthesia. In addition, some painkillers also cause these symptoms. It should be noted that gynecological operations are accompanied by nausea and vomiting in the postoperative period more often than other types of surgery. In many cases, the anesthesiologist can prevent nausea in the postoperative period by prescribing antiemetics before the operation itself. In the postoperative period, it is also possible to prevent nausea with the help of drugs (for example, cerucal). Home remedies for nausea prevention - ginger tea. In addition, many patients note that if they lie on their backs, then there is no nausea.

Pain. Almost every patient experiences pain of varying degrees in the postoperative period. You should not suffer and endure postoperative pain, as this can aggravate postoperative stress, lead to greater fatigue, and also worsen the healing process. Usually, after surgery, the doctor always prescribes pain medication. They should be taken as directed by your doctor. You should not wait until the pain appears, painkillers should be taken before they begin. Over time, postoperative wounds heal, and the pain gradually disappears.

fatigue. Many women experience fatigue after laparoscopy. Therefore, you should rest as much as you can. When you return to normal work, try to plan your rest. In addition, a daily multivitamin is recommended to restore strength.

Scar formation. Wounds after laparoscopy are much smaller than after other surgical interventions and they scar much faster. Unfortunately, it is impossible to completely get rid of scarring after an incision, since this is a physiological process. However, if desired, even these small scars can be eliminated by the methods that plastic surgery offers. In addition, today the pharmaceutical industry offers ointments that dissolve scars. However, they can only be used effectively with fresh scars. For the speedy healing of the wound, it is necessary to adhere to a complete diet rich in vitamins, minerals and proteins. Vitamin E is especially important for better healing, which is confirmed by many years of experience in its use. surgical postoperative constipation thrombophlebitis

Infection. Compared to other types of surgery, laparoscopy is much less complicated by infection. The infection can be both in the area of incisions and in the abdominal cavity, which can manifest itself as an infiltrate or abscess, which is much more serious. The main signs of infection of the surgical wound: redness in the wound area, swelling, pain and soreness when touching the wound, as well as discharge from the wound. If the infection develops in the abdominal cavity, then there may be pain in the abdomen, bloating, constipation, urinary retention or, conversely, frequent urination, as well as fever and deterioration in well-being. If you have these symptoms, you should immediately inform your doctor. To prevent infectious complications after abdominal operations, including laparoscopy, a short course of antibiotics is prescribed. You should not take any antibiotics on your own, and even more so, painkillers, before you are examined by a doctor.

Headache. It may seem paradoxical, but pain medications themselves can cause headaches. To eliminate them, you can use non-steroidal anti-inflammatory drugs, or acetaminophen. However, check with your doctor before using them. In addition, you can try lavender massage oil, which also has pain-relieving properties.

Hematomas and seromas. Sometimes fluid can accumulate in the area of the postoperative wound: ichor or serous fluid. This is manifested by swelling in the wound area, sometimes pain. Since the patient herself cannot find out what is hidden behind such complaints, it is necessary to consult a doctor for any changes in the wound area. Usually, hematomas and seromas can resolve on their own. To speed up this process, various thermal procedures are recommended in the wound area: at home, it can be a cloth bag with heated sand or salt. You can use electric heaters. In addition, you can use the services of a physiotherapy room. In the absence of the effect of these measures, a minor surgical intervention may be required: the doctor usually dissolves the suture and, using a small metal probe, releases the fluid accumulated under the skin. After that, the knapsack is washed and rubber drainage is left in it for a couple of days. The wound is covered with a sterile bandage. After a few days, the wound heals on its own.

2. Five classes of postoperative complications

Approximately 18% of patients after undergoing surgery experience one or another complication.

Some surgical complications develop frequently and in their manifestations they are relatively mild and do not pose any threat to health. Other surgical complications are rare, but they pose a certain threat not only to health, but also to the life of the patient.

In order to make it easier to navigate the likelihood of certain complications, as well as their severity, all postoperative complications are traditionally divided into five classes:

	Characteristics of complications	Examples of complications
	Mild complications that do not pose a threat to health, resolve on their own or require simple medications such as painkillers, antipyretics, antiemetics, antidiarrheals.	Cardiac arrhythmia that resolves after potassium administration Collapse of the lung (atelectasis), resolving after physical therapy Transient disturbance of consciousness that resolves on its own without any treatment non-infectious diarrhea Mild wound infection that does not require antibiotics
	Moderate complications requiring the appointment of more serious drugs than those indicated above. The development of these complications in most cases leads to an increase in the length of stay in the hospital.	Heart rhythm disorders Pneumonia Minor stroke followed by full recovery infectious diarrhea urinary tract infection wound infection Deep vein thrombosis
	Severe complications requiring reoperation. The development of these complications increases the duration of hospitalization.	Complications of this type are various disorders associated with the anatomical site of the operation. In most cases, all these cases require repeated surgery in an emergency or urgent manner.
	Life-threatening complications requiring treatment in the intensive care unit (intensive care unit). After this kind of complications, the risk of severe chronic diseases and disability is high.	Heart failure Respiratory failure Major stroke Intestinal obstruction pancreatitis kidney failure Liver failure
	Death

conclusions

Despite the fact that the main goal of any surgical intervention is to improve the patient's health, in some cases the operation itself is the cause of the deterioration of the patient's health.

Of course, not only the operation, but also the ongoing anesthesia or the initial serious condition of the patient can be a causal factor in the deterioration of health. In this article, we will consider the complications, the occurrence of which is associated with the conduct of the surgical intervention itself.

Firstly, all surgical complications can be divided into two groups:

common complications

Specific complications

Common complications occur with all types of operations. Specific complications are inherent in only one specific type (type) of operations.

Secondly, complications after operations can be divided according to the frequency of their occurrence. So, the most common general complications of operations are:

fever

atelectasis

wound infection

deep vein thrombosis

And, thirdly, operational complications may differ in terms of their occurrence. In particular, complications can occur both directly during the operation itself, and in a long-term period of time - after a few weeks or even months. Most often, complications after surgery occur in the early stages - in the first 1-3 days after surgery.

Bibliography

1. Gelfand B.R., Martynov A.N., Guryanov V.A., Mamontova O.A. Prevention of postoperative nausea and vomiting in abdominal surgery. Consilium medicum, 2001, No. 2, C.11-14.

2. Mizikov V.M. Postoperative nausea and vomiting: epidemiology, causes, consequences, prevention. Almanac MNOAR, 1999, 1, C.53-59.

3. Mokhov E.A., Varyushina T.V., Mizikov V.M. Epidemiology and prevention of postoperative nausea and vomiting syndrome. Almanac MNOAR, 1999, p.49.

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Causes of violations

Complications of hemorrhoids occur in the absence of treatment. The condition can worsen even after surgery. Pathology manifests itself in people regardless of gender and age. It is characterized by the expansion of the veins in the anus. The disorder often affects children as well.

Complications of hemorrhoids develop most often in patients with a latent form of the course. Due to the lack of obvious signs, the disease is diagnosed late, when the condition is already rapidly deteriorating. Deviation is usually discovered by chance.

Treatment of complications of hemorrhoids should take place under the close supervision of doctors. Additional violations may occur against the background of:

non-compliance with nutritional recommendations;
non-compliance with medical measures;
the introduction of an inactive lifestyle;
late visit to the doctor;
refusal to change preferences in sexual life;
self-treatment.

Diet options for hemorrhoids

Most often, the occurrence of complications is due to the lack of treatment or the adoption of self-selected medicines. Therapy should be selected by the proctologist, taking into account all individual characteristics.

Complications after hemorrhoid surgery are rare, but the likelihood of their manifestation still exists. The root causes of deterioration in the background of surgical intervention include:

improper procedure;
non-compliance with the recommendations of the doctor;
neglect of rehabilitation therapy.

Complications after removal of hemorrhoids usually have a pronounced intensity. In some cases, the patient may experience a recurrence of the disease.

One of the reasons for possible complications is a surgical error.

Varieties of disorders that have arisen against the background of hemorrhoids

Complications of internal hemorrhoids occur against the background of non-compliance with the recommendations of the doctor. The patient may show:

crack in the anus;
necrosis;
infringement of nodes inside the intestine;
anemia;
thrombosis.

Possible complications can be ruled out with recommended treatment, a strict diet, an active lifestyle, and good personal hygiene. If the first symptoms occur, you should immediately consult a doctor. The doctor will help reduce the risk of deterioration and eliminate the pathology.

In rare cases, complications may not manifest themselves for a long time. It is important that the patient carefully monitor their well-being.

If there is bleeding, anemia may develop.

anal fissure

A fissure in the anal sphincter area is the most common complication of pathology. It manifests itself against the background of constant constipation. When defecating, a person is very tense. For this reason, a deviation occurs.

Violation appears:

the presence of blood in the stool;
severe pain syndrome.

A rupture can lead to infection. An immediate consultation with a proctologist is required. The pain syndrome in the presence of a crack directly depends on the depth of its localization. If left untreated, the symptom may become chronic.

Anal fissure requires mandatory treatment

Necrosis and infringement of nodes

Such complications after hemorrhoids as necrosis and infringement of nodes are not uncommon. Occur at 3-4 degrees of pathology. Significantly worsen the patient's well-being.

Necrosis is a consequence of the prolapse of hemorrhoids, which are pinched in the anal canal.

Complication leads to:

impaired blood flow;
malnutrition of hemorrhoids.

With necrosis, the patient feels severe and sharp pain. Hemorrhoids become purple-blue. A strangulation occurs when knots fall out in a constipated patient. The anal passage narrows and the anus swells.

Necrosis of hemorrhoids is usually accompanied by poor health

paraproctitis

Paraproctitis is accompanied by the formation of an abscess. Purulent neoplasms are observed. Violation can be diagnosed when:

redness of the skin around the anus;
pain syndrome;
fistulas.

The patient in the presence of complications notices purulent discharge. Pathology can be chronic and acute. The disorder requires surgical intervention.

The operation consists in excision of the fistulous tract. The complication is established through differential diagnosis. Conservative methods are not effective.

Fistulas can be of different types

Anemia

Anemia or anemia leads to a decrease in the amount of hemoglobin in the blood. Pathology provokes the appearance of:

weaknesses;
loss of strength;
frequent mood swings;
lack of appetite;
dizziness;
memory impairment;
tachycardia;
shortness of breath;
pain in the region of the heart.

If left untreated, the pathology can become chronic. Gradually, oxygen starvation begins in the patient's body. The process of breathing becomes much more difficult. Accompanied with hemorrhoids, pathology causes great discomfort. The patient has difficulty even performing daily tasks.

Drowsiness is one of the symptoms of anemia.

Thrombosis

Thrombosis of hemorrhoids is a complication that not only increases the pain syndrome, but also poses a great danger to the patient's life. The reasons for such a violation in hemorrhoids include:

spontaneous increase in intra-abdominal pressure;
hypothermia;
traumatization of the anus.

Thrombosis against the background of increased intra-abdominal pressure occurs due to excessive physical activity. A provoking factor may be lifting a heavy object or straining.

In the presence of hemorrhoids, it is important to avoid hypothermia. Otherwise, thrombosis of the hemorrhoid develops against the background of stagnant processes in it.

High physical activity can lead to thrombosis of arterial nodes

Hemorrhoids provoke complications in the form of thrombosis of the hemorrhoidal node only at stages 3 and 4 of the disease. At the initial stages, there is no violation.

Complication is accompanied by:

pain syndrome;
swelling of the hemorrhoid;
bleeding;
redness of the affected area.

The disorder needs to be consulted by a doctor. It cannot be removed on its own.

Complications after surgery

Complications after surgery to remove hemorrhoids appear in all patients. Their severity and quantity depends on the quality of the procedure. Therefore, it is important to contact only highly qualified and proven doctors.

After the operation, you must follow all the recommendations of the doctor

Often patients do not even know if there are complications after hemorrhoid surgery. Surgery can cause:

suppuration;
narrowing of the anus;
fistula formation;
individual intolerance.

Complications usually occur on the 3rd-5th day of the rehabilitation period. When they appear, it is important to consult a doctor.

Suppuration can appear 1-3 days after manipulation. This indicates that an infection has entered the patient's body. Violation is accompanied by fever and fever.

Sometimes a second operation is required

If suppuration occurs after a week, the root cause is an insufficient level of personal hygiene. That is, the complication manifested itself through the fault of the patient himself. After surgery, the anal passage may narrow. However, only in 3 cases out of 10 the patient will need help in the form of surgery. The rest of the sick complication does not cause any discomfort.

local complications. Complications in the area of the surgical wound include bleeding, hematoma, infiltrate, suppuration of the wound, divergence of its edges with prolapse of the viscera (eventration), ligature fistula, seroma.

Bleeding can occur as a result of insufficient hemostasis during surgery, slipping of the ligature from the vessel, and bleeding disorders.

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

Hematoma is formed in the tissues from the blood coming from the bleeding vessel. It dissolves under the action of heat (compress, ultraviolet irradiation (UVI)), 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 with the formation of zones of necrosis and hematomas, inadequate drainage of the wound in obese patients, the use of a material with high tissue reactivity for the suture on the subcutaneous fat. Clinical signs of the infiltrate appear on the 3-6th day after the operation: pain, swelling and hyperemia of the wound edges, where a painful induration without clear contours is palpated, worsening of the general condition, fever, 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 the infiltrate, but the inflammatory phenomena are more pronounced.

Clinical signs appear by the end of the first - the beginning of the second day after the operation and progress in the following days. Within a few days the patient's condition approaches septic.

When the wound is suppurated, the sutures must be removed, its edges parted, the pus released, the wound sanitized and drained.

eventration- the exit of organs through the surgical wound - can occur for various reasons: due to deterioration in tissue regeneration (with hypoproteinemia, anemia, beriberi, exhaustion), insufficiently strong tissue closure, 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 often occurs on the 7-10th day or earlier with a sharp increase in intra-abdominal pressure and is manifested by a 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, peritonitis.

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

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

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

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

Seroma- accumulation of serous fluid - occurs in connection with the intersection of the lymphatic capillaries, the lymph of which is collected 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.

Seroma treatment, as a rule, is limited to one or two evacuations 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 an operating injury on the body and are manifested by a 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 the operation, mental disorders are much less common. For insomnia, sleeping pills are prescribed. Mental disorders are found in debilitated patients, alcoholics after traumatic operations. With the development of psychosis, an individual post should be established, a doctor or psychiatrist on duty should be called. To calm patients, thorough anesthesia is carried out, antipsychotics (haloperidol, droperidol) are used.

Complications from the respiratory organs. Bronchitis, postoperative pneumonia, atelectasis occur due to impaired lung ventilation, hypothermia, and most often develop in smokers. Before surgery and in the postoperative period, patients are strictly forbidden to smoke. For the prevention of pneumonia and atelectasis, patients are given breathing exercises, vibration massage, chest massage, jars and mustard plasters, oxygen therapy, and a semi-sitting position in bed. It is necessary to exclude hypothermia. For the treatment of pneumonia, antibiotics, cardiac agents, analeptics and oxygen therapy are prescribed. With the development of severe respiratory failure, a tracheostomy is applied or the patient is intubated with the connection of breathing apparatus.

Complications from the cardiovascular system. The most dangerous 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 bubbling rales in the lungs, increased heart rate, a drop in blood 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 carry out oxygen therapy. According to the doctor's prescription, cardiac agents (corglicon, strophanthin), neuroleptics are administered, adequately compensate for blood loss.

Acute thrombosis and embolism develop in severe patients with increased blood clotting, the presence of cardiovascular diseases, varicose veins. In order to prevent these complications, bandage the legs with elastic bandages, give an elevated position to the limb. After the operation, the patient should start walking early. As prescribed by the doctor, antiplatelet agents (rheopolyglucin, trental) are used, with an increase in blood clotting, heparin is prescribed under the control of clotting time or low molecular weight heparins (fraxiparin, clexane, fragmin), coagulogram parameters are examined.

Complications from the digestive organs. 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, a 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 be manifested by nausea, vomiting, flatulence, non-excretion of gases and feces. In order to prevent patients, a nasogastric tube is inserted into the stomach, the stomach is washed and the gastric contents are evacuated, cerucal or raglan is administered parenterally from the first days after the operation. A gas outlet tube is inserted into the rectum, in the absence of contraindications, a hypertonic enema is used. For the treatment of paresis, as prescribed by a doctor, prozerin is administered to stimulate the intestines, intravenous hypertonic solutions of sodium and potassium chlorides, an enema according to Ognev (10% sodium chloride solution, glycerin, hydrogen peroxide 20.0 ml each), pararenal or epidural blockade, hyperbarotherapy.

Complications from the genitourinary system: The most common are urinary retention and bladder overflow. In this case, patients complain of severe pain over the womb. In these cases, it is necessary to isolate the patient with a screen or place in a separate room, reflexively induce urination with the sound of a falling stream of water, put heat on the pubic region. In the absence of effect, bladder catheterization is performed with a soft catheter.

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

Complications from the skin. Bedsores often develop in debilitated and debilitated patients, with prolonged forced position of the patient on the back, trophic disorders due to damage to the spinal cord. For prevention, a thorough toilet of the skin, an active position in bed or turning the patient over, timely change of underwear and bed linen are necessary. Sheets should be free of wrinkles and crumbs.

Effective cotton-gauze rings, lining circle, anti-decubitus mattress. When pressure sores occur, chemical antiseptics (potassium permanganate), proteolytic enzymes, wound healing agents, excision of necrotic tissue are used.

Timing of suture removal

The timing of suture removal is determined by many factors: the anatomical region, its trophism, regenerative features 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 the surgical wound heals by primary intention, the formation of a postoperative scar occurs on the 6th - 16th day, which makes it possible to remove the sutures at this time.

So, stitches are removed after operations:

on the head - on the 6th day;

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

Requiring a wide opening of the abdominal wall (laparotomy or abdominal surgery) - on the 9-12th day;

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

after amputation - on the 10-14th day;

in the elderly, debilitated and oncological patients due to reduced regeneration - on the 14th-16th day.

Rice. 9.1. Removal of 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 with scissors and tweezers (Fig. 9.1). One of the ends of the knot is captured with tweezers and pulled in the opposite direction along the seam line until a white segment of the ligature appears from the depth of the tissues. In the area of the white segment, the thread is crossed with scissors or a scalpel. The ligature is removed with tweezers with an energetic upward movement so that the ligature section that was on the skin surface does not extend through the tissue. A continuous seam is removed with separate stitches according to the same principle. The removed threads are thrown into a tray or basin. The area of the postoperative scar is treated with 1% iodonate solution and covered with a sterile bandage.

Control questions

1. What is called a surgical operation? List the types of surgeries.

2. Name the stages of surgical operations.

3. What is the name of the operation of removal of the stomach in case of stomach cancer, removal of a part of the mammary gland in case of benign formation, removal of the sigmoid colon to the anterior abdominal wall in case of rectal injury?

4. What effect does the surgical operation have on the patient's body?

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

6. What is the significance 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 allow you to determine the dysfunction of the circulatory organs?

9. What tests can detect respiratory dysfunction?

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

11. What tests are used to judge kidney dysfunction?

12. What is called the postoperative period? 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.