Laparoscopy - a modern, minimally invasive method of operation, in which the surgeon produces several small holes in abdominal cavity, with their help the doctor conducts diagnostic and medical events.
Currently, this type of access is used in the diagnosis of many diseases and is widely distributed, since it is small-acting, requires a smaller period of recovery, does not leave the scars after himself.
Despite its advantages, laparoscopy is surgical intervention, therefore, has some restrictions in the postoperative period. The patient requires special nutrition, in the hospital, restriction of physical exertion. Cheating a child - stress for the body of the mother, so pregnancy after laparoscopy is possible, but after a certain amount of time after the operation.
Indications and contraindications
Laparoscopy is a method operational interventionhaving their pros and cons. To the positive moments of this type of surgery include the rapid restoration of intestinal functioning, a smaller stay in the hospital, a decrease painful sensations and scars.Another plus of laparoscopy is the expansion of the surgeon review, since during operation, special equipment is used, increasing the image at 20 or more times.
The minuses of laparoscopy include the complexity of its holding, this operation requires a surgeon of special skills. With such interference there is no sense of depth, the range of movements of the doctor is narrowed. Laparoscopy specialist should have developed "non-attormative" skills, since the blade of the tool is directed to the opposite direction.
On the modern stage Laparoscopy medicine is used in many diseases, including gynecological. Planned operations of this type are used in the following pathologies:
- cysts, tumors, ovarian polycystosis;
- the growth of the epithelium of the Mattake
- chronic pelvic pain;
- miomatomatosis of the uterus;
- safety Process B. uterine pipesoh.
Rehabilitation after laparoscopy:
Postoperative period
Usually laparoscopy is made under general anesthesia, the patient wakes up 2-3 hours after the operation. At this time, he may have painful sensations in the field of punctures, painkillers (ketorol, diclofenac) are used to relieve them. Also, the patient may have vomiting, nausea, dizziness, unpleasant feeling in the throat from the tube - the consequences of anesthesia.Get up recommended earlier than 8 hours after surgery And only for the need. Patients are carried out preventive therapy Antibiotics of the wide sector action. Postoperative seams are filmed in a week, until that time you should not take a bath, raise things more than 3 kilograms. It is not recommended to have sex intimacy 2 weeks, return to sports activities You can in a month.
The first day after laparoscopy is not recommended to eat, only water without gas is allowed. The next day, the diet should include brows and soft porridges. The first 5 days need to limit the consumption of fresh vegetables and fruits, all food must be cooked for a pair. Within 1 month after surgery, it is not recommended to use roasted, smoked, acute food.
Scars after 4 months from the date of laparoscopy:
Pregnancy after laparoscopy
Laparoscopy can not be the cause female infertion, after its execution, the chances of pregnancy are not reduced, and sometimes even rises. According to statistics during the year after this operation, it is possible to conceive a child 85% of patients. The remaining 15% have pathologies that are not related to surgical intervention.Approximately 15% of women who have moved laparoscopy will be pregnant month later. Another 20% of patients manage to conceive a child in the middle of half a year after the operation. The rest of the women will be pregnant on time from 2 to 6 months.
Attention! The time through which the woman should try to conceive a child depends on its condition and diagnosis, therefore, in this matter, it should be followed by the doctor's advice.
Pregnancy after the laparoscopy of the uterine pipes on the adhesions is possible 4 weeks after the operation. With this operation, the greatest probability of its occurrence is within a period of up to three months after surgical intervention. Later is possible a recurrence of pathology. If a woman was held laparoscopy about a pipe pregnancy, the following attempt was recommended to be postponed for 2-3 months, since the body takes time to restore.
Plan the pregnancy after laparoscopy to remove the cyst of the ovarian follows no earlier than in a month, the exact time depend on the state of the woman. Usually the body resumes its operation in a few days, but if this period is lengthened, attempts to conceive a child are a little postponed. When the ovarian laparoscopy over infertility on the background of polycystosis is planned to plan a pregnancy in the next menstrual cycle. At later dates there is a high probability of recurrence.
Attempts to conceive a child with laparoscopic interventions due to the Moma of the uterus should begin at least a month after the operation. The body takes time to restore its functions and buildings. Sometimes this period may increase, to clarify the recommendations, you need to consult with the attending physician.
With laparoscopy endometriosis, the doctor migrates pathological sections in the epithelium of the uterus. For their healing, a certain period of time is required, it depends on the size of the hearth and localization of the process. On average, pregnancy planning after this intervention is to begin after 2 months, a doctor defines more specific time.
Pregnancy planning after laparoscopic interventions during appendicitis, cholecystitis and other acute diseases should be started at least 2 months after surgery. The body must return to physiological state After transferred pathology, which causes inflammatory reactions and changes in the operation of all systems.
#one. Calculate ovulation. There are 2-3 days in the menstrual cycle, when the egg is ready to merge with spermatozoa. So as not to miss ovulation, a woman is recommended to take advantage calendar methodor special test.
# 2. Have sexual intercourse every 2 days. With too frequent intimate proximity, the spermatozoa do not have time to accumulate in the right amount.
# 3. Lead a healthy lifestyle. When planning a child should be observed proper nutrition, refuse to use nicotine and alcohol.
#four. Do not get out of bed within 30 minutes after sexual intercourse. For horizontal position Women There is a high probability of spermatozoa from the vagina in the uterus and the uterine tubes.
Laparoscopy ovarian is a source, convenient for everyday use the name of a number of operations on ovarian Women running using laparoscopy techniques. Doctors usually call these therapeutic or diagnostic manipulation data with laparoscopic operations. Moreover, the organ on which surgery is performed, most often not indicate, since it is understandable from the context.
In other cases in surgery More accurately formulate the essence of this therapeutic manipulation, indicating not only the use of laparoscopy techniques, but also the type of operation produced, and an organ subjected to intervention. An example of such detailed names is the following - laparoscopic removal of the cyst of the ovaries. In this example, the word "laparoscopic" means that the operation is performed using a laparoscopy technique. The phrase "cyst removal" means removing cystic education. And the "ovary" means that the doctors remove the cyst of this particular organ.
In addition to the deserted cyst, the foci of endometriosis or inflamed areas of the ovarian fabrics, etc. can be removed during laparoscopy. The entire range of operations of operations can be produced by a laparoscopic method. Therefore, for the full and correct name of the intervention, it is necessary for the word "laparoscopic" add type of operation, for example, removal of cysts, foci of endometriosis, etc.
However, such long names of interventions on the household level are often replaced by a simple phrase of the "ovarian laparoscopy", uttering that a person implies that a laparoscopic operation was produced on the ovaries of a woman.
Ovarian laparoscopy - definition and general characteristics of the operation
Under the term "ovarian laparoscopy" means several operations on the ovaries produced by the laparoscopic method. That is, the ovarian laparoscopy is nothing more than the surgical operations on this body, for the production of the laparoscopy technique. To understand the essence of laparoscopy, it is necessary to know what is the usual technique and methods of conducting surgical operations on the abdominal organs and a small pelvis. So, the usual ovarian surgery is performed as follows - the surgeon cuts the skin and muscles, spreads them to the sides and through the hole done by the hole sees the organ. Next through this incision, the surgeon removes the affected ovarian fabrics different ways, for example, deals with the cyst, focus on the electrodes of endometriosis, removes part of the ovary along with the tumor, etc. After completing the removal of the affected fabrics, the doctor signs (processes) the cavity of the small pelvis special solutions (for example, dioxidine, chlorhexidine, etc.) and sews the wound. All operations performed using such a traditional abdominal cut are called laparotomic, or laparotomy. The word "laparotomy" is formed from two morpheme - Lapar (stomach) and Tomiya (incision), respectively, his literal meaning is the "abdominal cutting".
The laparoscopic operation on the ovaries, in contrast to the laparotomic, is made not through the cut of the belly, but through three small holes with a diameter of 0.5 to 1 cm, which make on the front abdominal wall. In these holes, the surgeon introduces three manipulators, one of which is equipped with a camera and a flashlight, and the other two are designed to hold the tools and removing the cut-off tissue from the abdominal cavity. Next, focusing on the image obtained from the camcorder, the doctor two other manipulators produces need operation, for example, leads out the cyst, removes the tumor, the foci of endometriosis or polycystosis, etc. After the operation is completed, the doctor removes manipulators from the abdominal cavity and sews or strips three holes on the surface of the front abdominal wall.
Thus, the whole move, the essence and a set of operations on the ovaries is completely the same as with laparoscopy and at laparotomy. Therefore, the difference in laparoscopy from the ordinary operation is only in the method of access to the abdominal organs. With laparoscopy, access to the ovaries is performed using three small holes, and with laparoscopy - through a cut on the abdomen 10 - 15 cm long. However, since laparoscopy is much less traumatic compared to laparotomy, currently a huge number of gynecological operations on various organs, including ovaries, is made by this method.
This means that indications for the production of laparoscopy (as well as to laparotomy) are any diseases of the ovaries that cannot be cured conservatively. However, due to low traumaticity, laparoscopy is used not only for operational treatment ovaries, but also for diagnosis various diseaseswho are hard to recognize with others modern methods surveys (ultrasound, hysteroscopy, hysterosalpingography, etc.), since the doctor may inspect the body from the inside using the camera and, if necessary, take fabric samples for subsequent histological research (biopsy).
Benefits of laparoscopy in front of laparotomy
So, operations on the ovaries of women, carried out using a laparoscopic method, have the following advantages over the manipulations produced during the laparotomy:- Less traumatization of tissues, since cuts with laparoscopy are much less than at laparotomy;
- The smaller risk of the development of the adhesive process, since during laparoscopy, the internal organs are rolled and squeezed not as much as during the laparotomic operation;
- Postoperative rehabilitation after laparoscopy occurs several times faster and easier than after laparotomy;
- Low risk of infectious inflammatory process after operations;
- Practically complete absence risk of discrepancy of seams;
- Lack of big scar.
Total framework laparoscopy scheme
Any laparoscopic operation on the ovaries is made in compliance with the following steps:1. A man gives common anesthesia.
2. The surgeon makes the belly on the skin three or four cuts with a length of 1.5 - 2 cm, after which the muscles and soft tissue spreads with the probe so as not to wander the internal organs.
3. Through the holes in the skin into the cavity of the small pelvis, hollow tubes - manipulators are introduced through which the introduction of tools (scalpels, scissors, electrocoagulants, etc.) and the removal of the affected belly fabrics is introduced.
4. First of all, after the introduction of tubes-manipulators into the cavity of the small pelvis, carbon dioxide is injected, which is necessary in order for the internal organs to deal with and moved away from each other for a short distance sufficient to their excellent review.
5. Through other tubes-manipulators, the doctor enters the chamber with a flashlight and surgical instruments into the cavity of the small pelvic.
6. A flashlight camera projects an image of a small pelvic organs on the screen, which the doctor looks at and evaluates the state of the ovaries.
7. Under the control of the image from the camera, the doctor produces all the necessary manipulations, after which the tube-manipulators removes and sews cuts.
Types of operations
Currently, with the help of laparoscopic access, the following operations on the ovaries in women of different ages can be performed:- Deepening various cysts (dermoid, epithelial, follicular, endometrioid, etc.);
- Removal benign formations ovaries (teratomas, serous or mucinous cystadenomes, etc.);
- Treatment of apoplexy of the ovary;
- Twisted legs of cysts or benign neoplasms;
- Removing foci of endometriosis;
- Treatment of polycystic ovarian syndrome;
- Removal of adhesions in the ovary area, uterine pipes, uterus and intestinal loops;
- Removal of the entire ovarian or any part of it;
- Diagnosis of the overall state of female genital organs and reasons for infertility.
1. Removal of benign pathological formations on the ovary, such as cysts, cysts (benign neoplasms), spikes, blood during apoplexy, etc.
2. The migation of foci of endometriosis and a large number of follicles in the syndrome of polycystic ovaries.
3. Removal of part or the entire ovarian in inflammatory and other diseases in situations where conservative treatment from full preservation fabrics are impossible.
Description of various types of ovarian laparoscopy
Consider overall characteristics, essence, method and testimony for various laparoscopic operations on ovaries.Laparoscopy of cysts or cysts (benign neoplasms) ovarian
To remove cysts or ovarian cysts, the following laparoscopic operations can be carried out: - Receiding ovarian (removal of the part of the ovary on which a cyst or a kistoma);
- AdhesEctomy (removal of the entire ovarian with a pystic or wet);
- Cystectomy (Cleaning cysts with the preservation of the entire ovarian).
The cystectomy operation is as follows:
1.
After the introduction of manipulators into the cavity of a small pelvis, the tongs for the biopsy is captured by the ovary.
2.
Then the ovary tissues are neatly below the border on which the cysts or cysts capsule is located. After that, the stupid end of scissors or forceps is separated by a neoplasm capsule from the main tissue of the ovarian, like how the chicken remove the skin.
3.
The torn cyst is placed in a container similar to a plastic bag.
4.
Scissors cut the wall of cysts or cysts.
5.
The edges of the cut stretch to remove the contents of cysts or cysts.
6.
Then inside the container, first produce the contents of the cyst, and then pull it out the capsule outside through one of the manipulators.
7.
After the removal of cyst electrodes, the vessels are burned on the surface of the ovary in order to stop bleeding.
8.
When blood stops, in the cavity of a small pelvis is poured antiseptic solution, for example, dioxidine, chlorhexidine or the other, so that it is well ringed all organs, after which it is sucking it back.
9.
Remove manipulators from the wound and apply 1 to 2 sutures for each cut.
Cystectomy In most cases, it allows you to successfully remove the neoplasm, leaving a woman a full and functioning ovary.
The resection of the ovary is made in cases where the area of \u200b\u200bthe body is affected irrevocably and remove only pathological neoplasm will not work. In this case, after the administration of manipulators, the ovary is captured by forceps and scissors, a needle electrode or a laser, and cut off the affected part. Remote fabrics are pulled out through the hole in the manipulator tube, and the ovarian incision is migrated to the electrodes in order to stop bleeding.
Removal of ovary during laparoscopy
Removal of the ovary during laparoscopy can be carried out during the operations of ovariectomy or adxectomy.Oboviectomy is an ovarian removal operation, to which they are resorted in cases where the entire organ turned out to be affected, and its fabrics will no longer be able to recover and perform the necessary functions. To perform ovariectomy after the administration of manipulators, the ovaries of the tongs are captured and cut off the bundles with scissors, holding the organ in its position. Then cut the mesentery of the ovary in which they pass blood vessels And the nerves of the body. After the cut of each bundle and mesenter makes the burden of blood vessels to stop bleeding. When the ovary turns out to be released from communication with other bodies, it is removed out through the hole in the manipulator.
AdhesEctomy is the removal of ovaries together with the uterine pipes. According to the principles of implementation, it is not different from ovariectomy, but used in cases where not only the ovaries are affected, but also the uterine pipes. As a rule, such situations are formed with severe chronic inflammatory diseases The abodes of a small pelvis when a woman has both adhesitis, and salpingitis, and hydraulic acids, etc.
Laparoscopy with ovarian polycystic
Polycystic ovarian syndrome (SPKI) is the cause of infertility that often does not succumb conservative therapy. In such situations, good and enough effective method The treatment of the disease is various laparoscopic techniques, allowing to eliminate the existing cysts and create conditions for the normal functioning of the ovaries in the future. Depending on the state of the ovaries, the following laparoscopic operations are manufactured in PCC: - Decorptication of ovarian , during which the dense upper body layer is removed by cutting it with a needle electrode. After removal of the dense layer, the follicles will be able to grow normally, ripening and bursting, releasing the eggs outward, and not leaving it in the follicular cavity, the wall of which is before treatment due to high density Could not break.
- Caiderization of ovarian In the course of which radial (circular) cuts 1 cm depth 1 cn are made on the surface of the ovary. The number of such cuts is 6 to 8 pieces. After catering, a new healthy tissue is growing in the places of cuts, in which the formation of normal follicles is possible.
- Wedge-shaped resection of ovarian In the course of which a wedge-shaped piece of fabric is carved in the area of \u200b\u200bone of the organ poles.
- Endothermocoagulation of ovarian , during which an electrode is introduced into the body of the organ to a depth of 1 cm, burning out electric shock Small hole. In total, there are about 15 holes on the ovary surface at a distance of 10 cm from each other.
- Electrotrilling ovarian In the course of which multiple cystic cavities are removed from the ovary surface by exposure to the electric shock.
Laparoscopy with endometriosis (including endometrioid cyst) ovarian
Laparoscopy with endometriosis (including endometrioid cyst) of the ovary is to burn ectopic foci (endometrial growth on the ovaries) electrodes, warp to high temperatures. If there is an endometrioid cyst, it is deepening on the same technique, as well as any other neoplasm of the ovary, after which the doctor carefully examines the entire abdominal cavity, migrating the detected foci of endometriosis.Laparoscopy with spikes, apoplexy of the ovary and twist the legs of the cyst
In the spikes, the doctor during laparoscopy produces their separation, gently cutting with scissors and, thus, released organs and tissues from the battles with each other. The apoplexy of the ovary is an abundant hemorrhage in the follicle, from which the eggs recently came out. When apoplexy during the laparoscopy, the doctor reveals the follicle cavity, sucks blood, after which there is a bleeding blood vessels, or removes a damaged part of the ovary.
Twist the legs of cysts is heavy pathologyAt which the long and narrow part of cystic formation is twisted around the ovary or uterine pipes. In the event of such pathology, during laparoscopy, the ovary is often completely removed, and the uterine tube with a pile, since it is not possible to divide them. Sometimes, with an incomplete twist of the legs of the cysts against the background of a healthy and relatively not affected ovarian, the organs are spinning, restoring the impaired blood flow and deserted cystic education.
General testimony and contraindications for ovarian laparoscopy
In a planned procedure, the laparoscopy of the ovaries is shown in the following states:- Infertility unclear origin;
- Suspicion of tumors, cysts or endometriosis;
- Chronic pelvic pain syndrome, which is not amenable to conservative treatment.
- Suspicion of the apoplexy of the ovaries;
- Suspicion to twist the legs of the cyst;
- Suspicion of a breakdown of cysts or cysts;
- Acute adhesitis, non-antibiotic therapy for 12 to 48 hours.
So, the carrying out of laparoscopy is contraindicated in the following states:
- Decompensated diseases of the respiratory or cardiovascular systems;
- Hemorrhagic diathesis;
- Acute renal or liver failure;
- Severe chronic liver or renal failure;
- Transferred less than 6 weeks ago acute infectious diseases;
- Active subacute or chronic inflammation uterine pipes or ovaries (an inflammatory process should be cured before carrying out laparoscopy);
- III-IV degree of purity of the vagina.
Preparation for ovarian laparoscopy
First of all, the following analyzes should be passed as preparations for laparoscopy of ovaries and surveys: - Common urine and blood tests;
- Definition of blood group and rhesus factor;
- Electrocardiogram;
- Biochemical blood test with the determination of glucose concentration, general protein, bilirubin;
- Blood for HIV, hepatitis B and C, syphilis;
- Mazzok from the vagina on the microflora;
- Analysis on blood clotting (coagulogram - APTTV, PH, MN, TV, fibrinogen, etc.).
Plan the date of laparoscopy follows any day menstrual cycle, with the exception of the direct monthly bleeding. When conducting an operation during menstruation, increased blood loss due to the strong bleeding and complexity of the bleeding stop.
After a positive decision on the possibility of carrying laparoscopy, on the basis of the results of the tests, a woman should be treated in a gynecological hospital, where immediately before the operation it will produce ECG and ultrasound of organs of a small pelvic and chest organs.
In the evening, on the eve of the operation, you should graduate from meals a maximum of 18-00 - 19-00, after which it is necessary to starve to laparoscopy. You can only drink until 22-00 pm a day on the eve of the operation, after which it is forbidden and drink, and is up to laparoscopy. Food and drink restriction is necessary to reduce the risk of casting the contents of the stomach in airways During the period of stay in anesthesia.
Also in the evening, on the eve of the operation, it is necessary to choke the pubery and make the enema. In the morning, immediately before the operation, another enema is performed. Sometimes doctors recommend that in addition to the enema additionally take the laxatives to carefully clean the intestine. The pure intestines are necessary in order to decrease its size, and he did not interfere with the operations on the ovaries.
How long does the ovarian laparoscopy operation last?
The duration of the ovarian laparoscopy can be different and range from 20 minutes to 1.5 hours. The duration of the operation depends on the complexity of the body's existing defeat, from the experience of the surgeon, as well as from the variety of intervention. Usually laparoscopy of the ovarian cyst lasts 40 minutes, but some very experienced doctorswhich only engage in such operations make them in 20 minutes. On average, the ovarian laparoscopy lasts about one hour.Postoperative period
The postoperative period of the laparoscopy of the ovaries continues from the moment the operation is completed and up to the statement of the gynecological hospital. Characteristic feature postoperative period of the ovarian laparoscopy is the earliest physical activity Women when they are allowed and even strongly recommended to get up from bed and make simple actions in the evening on the day of operation. Also 6 - 8 hours after the completion of laparoscopy is allowed to take liquid food. IN the following days Hospital stay is recommended to move and eat often, but small portions, as it contributes to the lowest restoration of the intestinal work.In the first 1 - 2 days, a woman can feel discomfort in the stomach associated with the presence of a gas used for laparoscopy. Gas pressure can also provoke painfulness In the region of the abdominal press, the legs, neck and shoulder. However, gas is gradually excreted from the abdominal cavity, and discomfort completely passes for a maximum of two days. Slender girls are experiencing the most pronounced discomfort from gas, and full, on the contrary, almost do not feel so.
Since the laparoscopy is minimal injuries, the use of painkillers after the operation is usually not required. However, if a woman is concerned with pain in the field of cuts or ovaries, doctors use non-marketal painkillers, such as Ketorol, Kathetonal, etc. only in very rare cases After large in terms of operations, for example, the removal of the uterus or excision of a large number of endometrial foci, there is a need to use narcotic anesthetic. However, any analgesics after laparoscopy are used for 12 to 24 hours, after which the need for use is eliminated.
Antibiotics after laparoscopy are also applied not always, but only with a large amount of intervention or in the presence of an infectious and inflammatory hearth in the cavity of a small pelvis. If all the small pelvis organs are normal, not inflamed, and the intervention was small, for example, the removal of cysts, then antibiotics after laparoscopy do not apply.
However, due to the relative long stay of a woman in the position of Trendelenburg (the head below the legs at 15 - 20 o) after laparoscopic operations there are relatively high risk Development of thrombosis and thromboembolism, therefore, in the postoperative period, anticoagulant therapy is required, aimed at reducing blood clotting. Optimal preparations for anticoagulant therapy in the postoperative period of the ovarian laparoscopy are the calcium and euxaparine sodium.
Depending on the volume of operation, the postoperative period lasts from 2 to 7 days, after which the woman is prescribed home from the hospital.
Laparoscopy ovarian cysts - hospital
After the laparoscopy of the ovary, a hospital leaf is discharged by 7-10 days, considering from the moment of extracting from the gynecological hospital. I.e, total duration Hospital for the ovarian laparoscopy is 9 - 17 days, after which the woman is allowed to start work. In principle, after discharge from the gynecological hospital, a woman can start work if it is not related to physical tension. After the laparoscopy of the cysts of the ovary (recovery and rehabilitation treatment)
The complete restoration of all organs and tissues occurs after 2 - 6 weeks after the laparoscopy of the cysts of the ovary.In the rehabilitation period, it is very important not only to carry out the necessary manipulations and activities aimed at the rapid restoration of the structure and functions of tissues, but also to comply with the prescribed limitations.
So, after laparoscopy, the following restrictions should be observed:
- Within one month after surgery, penalties should be observed. Moreover, women are advised to refrain from vaginal and anal sex, but oral variants of sexual intercourse are fully resolved.
- Any sport training It should be started no earlier than a month after the operation, and the load will have to be given with minimal, and gradually increase it to the usual level.
- Within a month after surgery, do not engage in severe physical labor.
- Within three months after surgery, do not lift more than 3 kg.
- Within 2 - 3 weeks after surgery, do not include sharp, salty, spicy dishes and alcoholic beverages in the diet.
The menstrual cycle after the laparoscopy of the ovaries is restored quickly, sometimes not even confusing. In some cases, menstruation can be somewhat lined with the planned date, but in the next 2 - 3 months will occur full recovery Normal for a woman cycle.
Since laparoscopy is a gentle operation, then after its fulfillment, women can freely live sexual life, pregnant and give birth to children.
However, the ovarian cysts can be formed again, therefore, in the presence of a tendency to such a disease, women after laparoscopy can be recommended to undergo an additional anti-reducing course of treatment with Gonadotropin-relocation of the hormone agonists (Bususrelin, Gozerelin, etc.) or androgenic hormones.
Ovaries after laparoscopy (pain, sensations, etc.)
The ovaries after laparoscopy immediately begin or continue to function in normal mode. In other words, the operation practically does not affect the work of the ovaries, which, before its production, functioned relatively normally, that is, the woman had a regular menstrual cycle, ovulation, libido, etc. If the ovaries to laparoscopy functioned incorrectly (for example, with polycystic, endometriosis, etc.), then after the operation, they begin to work relatively correctly, and the likelihood is quite high that the treatment will allow to get rid of the disease forever. Immediately after laparoscopy, a woman can disturb pain in the ovarian area in the middle part of the abdomen, which usually pass independently within 2 - 3 days. In order to reduce pain, it is recommended to fully relax and go gently, trying not to strain abdominal wall And do not touch the abdomen with various objects, including cramped clothing. If the pain is enhanced, and does not subscribe, then you should consult a doctor, as it may be a symptom of the development of complications.
Monthly after laparoscopy ovarian
Within 1 - 2 weeks after laparoscopy of ovaries, a woman may have scarce mucous membranes or bleeding from sex tract, which is the norm. If a bloody issues After laparoscopy is abundant, then you should consult a doctor, as this may indicate internal bleeding.The day of operation is not considered the first day of the menstrual cycle, so after laparoscopy, a woman does not need to adjust its calendar, because the estimated date of the next month remains the same. Menstruation after laparoscopy can come to their normal period or delay from the current day for a short period of time - from several days to 2 - 3 weeks. The nature and duration of menstruation after laparoscopy may change, which should not cause anxiety, because it is normal reactions of the body on the treatment.
Pregnancy after laparoscopy ovarian
It is possible to plan a pregnancy in 1 - 6 months after the laparoscopy of the ovaries, depending on the disease, about which the operation was carried out. If a cyst, cystom or spikes are deleted during laparoscopy, then you can plan a pregnancy one month after the operation. As a rule, in such cases, women will be pregnant within 1 - 6 months after laparoscopy.If the laparoscopy was made over endometriosis or polycystic ovarian syndrome, then it will be possible to plan a pregnancy only after 3 - 6 months after surgery, because during this period of time a woman will have to go through the course additional treatmentaimed at the complete restoration of the functioning of the ovaries and the ability to conceive, as well as to the prevention of relapses.
It should be remembered that laparoscopy in diseases of the ovaries increases the chances of pregnancy in all women.
Stomach discomfort after laparoscopy (bloating, nausea)
After laparoscopy for 2-3 days, the abdomen and nausea may be observed, which are due to the irritation of the intestine with carbon dioxide used for the operation. To relieve the scrawl of the belly, preparations containing simothykone, for example, espumizan, etc. Nausea does not require special treatment, because after 2 to 3 days it will be held independently.Diet after laparoscopy ovarian
Within 6 - 8 hours after surgery, only non-carbonated clean water should be dried, after which within 2 - 3 days you can eat liquid or crushed, masculine food, for example, a non-large broth, low-fat yogurt, boiled and rubbish meat, fish or rice. From 4 to 5 days, you can eat, as usual, excluding salted, spicy, sharp and alcohol. Laparoscopy won popularity in medicine, now it is the most common type of surgical intervention, which is used to diagnose and treat various diseases. Over the past decades, operations through laparoscopy began to be used in gynecology. Previously, such operations were made only by the open method, as a result, the patient was waiting for mass unpleasant sensations, ugly scars on the body, long rehabilitation.
Conducting such an operation significantly reduces the risk of recurrence of the disease. Laparoscopy is often used when removing cysts in the uterus.
Laparoscopy. Indications
Laparoscopic operations are widely used in gynecology:
Infertility of unclear origin, the reason for which was not able to find out with a detailed non-invasive study.Suspicion of spikes.
Myoma uterus.
Suspicion of endometriosis.
Flash disease.
Internal bleeding.
Ectopic pregnancy.
Survey of small pelvis.
Chronic pelvic pains etc.
Benefits of laparoscopy
Turning to B. medical Center For help, the patient expects to quickly recover and return to a normal lifestyle. If doctors resort to laparoscopy, with such operational form There is no interference with big blood loss, and after such an operation, the woman quickly becomes legs. Patients who transferred such an operation in the ward intensive therapy There are only a few hours. Seams, scars after surgery are often invisible, and there are no no at all.
The cost of a laparoscopic operation depends on the disease, its degree of gravity, but at the same time it is quite democratic.
After laparoscopy
After laparoscopy, the ovarian cysts occurs the period of rehabilitation, which will continue for 3-4 weeks. Patients need to remember that recovery general well-being and healing wounds in the place of punctures goes much faster than healing internal organs. To secure the result obtained after laparoscopy, it is necessary to strictly observe the advice and appointment of the attending physician.
First day after laparoscopy
In the first hours after laparoscopy, the patient continues to move away from the general anesthesia, there is a state of "half the weather". In most cases, the appearance of a feeling of cold and chills is noted. To eliminate the above sensations, you need to hide the warm blanket. The pain syndrome after laparoscopy is moderate, to eliminate it is enough to receive painkillers. In some cases, vomiting may appear and the feeling of nausea, which are eliminated using special preparations. There may be consequences of using anesthenous tube, the patient will have a feeling of small discomfort. Lifting from bed and walk to the toilet after laparoscopy patients are allowed 5-6 hours after surgery. But at the same time it is necessary to remember that it is not worth moving too much, you need more time to get rest and rest, since the patient's condition is characterized by severe weakness for several days.
Immediately after laparoscopy, you must eliminate meals. If the patient has no nausea and vomiting, you can drink no carbonated water.
A day after laparoscopy
A day after the laparoscopy, the patient feels small pain or discomfort in the shoulders and neck. This state appears as a result of the use of gas, which was supplied under pressure on the diaphragm. Painses are removed medicinal preparations Analgesics. After removal of the ovarian cyst, there are bleeding, which should not scare the patient, it can be extraordinary menstruation. After laparoscopy, you need to pay attention to the organization. It is recommended to avoid the use of coarse food. It is not recommended to use smoked meats, fatty and sharp dishes. It is worth avoiding the use of dishes that enhance the bloating and gas formation in the abdominal cavity. Preferences need to be given to light products, low-fat varieties of meat, fish and vegetables that are boiled or prepared for a pair. Recommended the use of fermented milk products, morse, tea, mineral water without gas.
Compliance with rules within a month after the procedure
During postoperative rehabilitation, the period of which lasts about a month must comply with certain rules. You should avoid familiar loads, since the first days after laparoscopy may be accompanied by weakness, fast fatigue. Well, if there will be a person who is capable of assisting next to the patient. Determine the rest time and motor activity The patient must, guided by his well-being. Resume sex life is recommended no earlier than 2-3 weeks after laparoscopy of the ovary cysts. As for physical exertion (fitness, sport, dancing), it is possible to resume occupations in 3-4 weeks after the operation. During the first week, the classes should be started with minimal loads, gradually bringing to the usual norm. Not recommended to do sharp movements And lift gravity, it is allowed to raise the cargo weighing 3-5 kilograms. It is forbidden to perform long trips and flights. Avoid hot bath, bath or sauna. It is necessary to take a warm shower and do not rub the seams with a washcloth until they completely lish. This period takes approximately 10 days. The daily processing of seams by antiseptics is required, which can be used "green" and "manganese". Handle seams need to full healing. You can not swim in the pool, river, sea. After laparoscopy, it is necessary to wear clothes that will not put pressure on the seams. The first menstruation after laparoscopy may differ from the usual monthly abundance of secretions and pain in the abdomen.
Laparoscopy is surgery According to resection of the affected organ or its part, performed through small incisions by means of trocars and laparoscope. In addition, the laparoscopic method is used to diagnose diseases, as extremely accurate.
One of the prerogative aspects is a shortened postoperative period of laparoscopy. Rehabilitation passes in accelerated mode, since the tissues and skin cover are not injured, as with a curly operation. For the same reason, the possibility of infection of cuts and the formation of adhesions is reduced to a minimum.
On the technique of conducting and types of laparoscopy
Laparoscopy is carried out under the action of anesthesia. In the field of operated organs, several cuts are made through which surgical instruments and laparoscope are introduced - a device equipped with a lighting component and a video camera. The image enlarged at times is projected onto the monitor.
For better visualization of internal space, and access to organs, carbon dioxide is supplied to the operated region. Under its influence, the folds of the abdominal cavity are spread, which allows the surgeon to fully work. At the end of the process, the toolkit is retrieved, and they are superimposed surgical seams. Most often laparoscopic surgery is carried out on the organs of digestive and gOOD SYSTEM, less like chest (Thoracic surgery).
The most demanded operations include:
- appendectomy (appendicitis);
- kolactomy (removal of the sewing department);
- cholecystectomy (excision of the gallbladder with a tumor process and gallway disease);
- herneoplasty (removal of umbilical hernia);
- kistectomy (resection of the cyst of ovary, kidneys, liver)
- distal resection of the pancreas;
- gastrectomy ( full removal stomach).
In addition, laparoscopic excision of seed veins in men in varicocele (varicose veins of scrotum and seed cake), gynecological operations for endometriosis (the growth of the uterus cells), the mioma (benign tumor) of the uterus, numerous inflammatory processes in the organs of the small pelvis. Laparoscopy, according to emergency testimony, is allowed to produce during pregnancy.
Appendicitis or cholecystitis may occur in the perinatal period. Pregnancy is not a contraindication to laparoscopic intervention
The consequences of laparoscopic surgery
The laparoscopic method of carrying out resection is transferred to patients easier than the usual extension operation. However, as any extraneous intervention in the body, surgery or diagnosis do not pass without a trace for the patient. The consequences of laparoscopy are usually manifested during the patient's stay in the hospital after the operation, but sometimes they may arise after discharge. To the mainstream by-effects relate:
- Pain syndrome . During the first twelve hours after the operation, intense pains are not considered an abnormal phenomenon. Damage to soft tissues, skin cover and internal organs cause pain that are localized in the area of \u200b\u200bthe operated authority, and may also be irradiating (to give) top Cases. Analgesics, nonsteroid and anti-inflammatory drugs are used to eliminate painful sensations in the hospital. Less often used opium alkaloids (opiates).
- Feeling of cutting in the abdominal cavity. This symptom It is triggered by the introduction of carbon dioxide during the operation. Intensive accumulation of gases in the abdominal cavity is not postoperative pathology. If the symptom does not leave the patient in the first postoperative day, the wind turbines are prescribed.
- The severity in the epigastric (sublext) region, nausea. Arise after laparoscopy operation, as a result of the introduction of anesthesia. Such sensations do not need special treatmentAnd pass by yourself.
- Headaches . May be caused by transferred anesthesia and excitement, which is experiencing a patient. As a rule, they are stopped by analgesics together with painful syndrome In the field of operation. With an excessively excited state of the patient, sedative medicines are prescribed.
- Discomfort in the throat and esophagus. The cause of the occurrence is the use of endotracheal anesthesia (the introduction of anesthesia through the respiratory tract through the tube). These symptoms are short-lived, treatment does not require.
The intensity of postoperative symptoms depends on the individual characteristics of the body's patient and the quality of surgery.
Little sections on the body after laparoscopy are healing faster than scars after a strip resection
Possible negative manifestations
Complications after laparoscopy - a rare phenomenon, but encountered. The emergence of complications is due to three main reasons: an unforeseen patient reaction on anesthesia or the introduction of carbon dioxide, non-compliance with the patient of medical recommendations during the recovery period, a poorly conducted operation (medical inattention, errors).
Complications of anesthesia
Before laparoscopy, the patient passes a survey that helps a anesthesiologist to pick up which better anesthesia (drug and dosage) will fit concrete person Taking into account his individual characteristics. Inadequate reaction rarely occurs, the most extreme form of manifestation may be acute allergic reaction - anaphylactic shock. Failure in the work of bronchopulmonary and cardiac activity can occur under the influence of carbon dioxide. Complication is rare, depends on individual characteristics (chronic heart and bronchi diseases), or abnormative gas administration.
Pathological manifestations due to the fault of the patient
Each doctor necessarily provides recommendations after laparoscopy that the patient must be carried out in the rehabilitation period. There are restrictions in nutrition, as well as prohibitions on a serious physical burden after the operation to remove the affected organ or its site. In case of non-compliance with the recommendations, suppuration and infection of seams, bleeding, inflammatory processes in the bustling bubble, urinary, urinary system and other abdominal and small pelvis organs are occurring.
Complications depending on medical personnel
An illiterate operation or malfunction of equipment may be threatened with certain negative consequences. Patients with chronic heart activity disorders, atherosclerosis, varicose veins are introduced by drugs that dilute blood. If the doctor ignored this manipulation, the danger of the formation of blood clots arises. In case of failures in the work of a laparoscope or inappropriate qualifications of the doctor, the risk of injury of related organs and vessels arises. For example, removing stones from the gallbladder, an inexperienced doctor can damage its walls.
A special danger is a primary puncture, produced by a needle of the vest, when the laparoscope does not yet function. Manipulation blindly can lead to bleeding. The emergence of the adhesive process is most characteristic after resection of appendicitis. To stop standard bleeding after the excision of the part of the organ, the coagulation method is used (by electric filling). The incorrect use of the method causes strong burns of internal organs. Completing the affected area, a doctor, can burn the adjacent body, which will entail the development of necrosis (motion) of body tissues.
Violation of sterility with medical personnel is the cause of the intra-infection, and as a result, the emergence of a purulent-inflammatory process in the seam area. The incorrect removal of an organ affected by the oncology can cause damage to cancer when extracting it from the abdominal cavity. Appearance postoperative Gryzh due to the irregular embossing of the trocked holes after the removal of large fragments of the organs. This complication It may not immediately declare themselves immediately after laparoscopy, but after a few weeks or months.
Errors In operations on resection of the gallbladder lead to a violation of the choleretic process, which can be serious diseases Liver. Special attention requires pregnancy during the operation period. With careless acts of the doctor, there is a threat of interrupt (miscarriage) or the development of oxygen deficiency (hypoxia), as a reaction to the introduction of carbon dioxide. If unforeseen situations occur during laparoscopy, the doctor must move to open laparotomy to avoid more serious negative consequences.
The listed complications can be prevented if you carefully select the clinic for the operation. In addition, the patient needs to clearly fulfill all the advice of the doctor in the rehabilitation period.
The main symptoms of complications
Immediate appeal to medical help Requires the appearance of the following symptoms:
- strong pain sensations in the operated area after discharge from the hospital;
- stable hyperthermia (elevated temperature);
- changing the color of the epidermis (skin) around the scar on the bright red;
- isolation of the purulent blood substance in the area of \u200b\u200bincisions;
- constant headache, short-term attacks of loss of consciousness.
By the end of the stay in the hospital, sharp postoperative pain should not be
Patient must be hospitalized, to hold ultrasound diagnostic, Take blood tests.
Postoperative period after laparoscopy in stationary conditions It lasts from 3 to 6 days, depending on the complexity of the operation. In the future, the patient goes on outpatient treatment. Rehabilitation after a laparoscopic operation, as a rule, passes in accelerated mode. The seams, depending on the surgical material used, are removed by 7-10 days or they are dissipated in the body independently.
After a month, working capacity is restored completely. The patient's responsibility includes the fulfillment of all recommendations for compliance with the regime and diet. For the month, the operated person should not resort to heavy physical Loads. Cannot do power exercise And lift gravity. Nevertheless, rational physical activity is shown from the second day after the operation to avoid the development of the adhesive process.
One of of essential factors It is proper nutrition in the postoperative period. In the first days, the diet should consist of fastened broths, oatmeal. Being on an outpatient treatment, the patient must adhere to lightweight food. The diet is based on the use of the following products:
- puree soups;
- river I. sea \u200b\u200bfishcontaining less than 8% fat;
- meat turkey, chicken;
- protein omelet and eggs, boiled sick.
- degreased cottage cheese, unsolved cheese;
- porridge, pasta;
- potato, fruit-berry puree.
Eliminate from the diet you need:
- fat meat;
- fatty sauces on mayonse basis;
- dishes from lentils, peas, beans;
- baking from a dough test;
- sharp and smoked products.
Compliance with the recommendations of doctors - the basic condition for the prevention of complications
It is strictly prohibited by consumption alcoholic beverages. Rough food can cause difficulties and pain in its recycling by organs digestive tract. Combination (constipation) negatively affects the well-being and state of postoperative seams. When manifesting these symptoms, laxatives are recommended or enema.
In addition to the shortened recovery period, laparoscopy prerogatives before extensive operation It is considered: a meager probability of adhesion formation (subject to the patient with the recommendations of the doctor), aesthetic appearance of scars (less than a year after the consequences of the operation cease to be noticeable). In the absence of contraindications, the laparoscopic method of surgical intervention is preferred.
The diagnostic type of laparoscopy is assigned in the case when setting is difficult exact diagnosis For diseases in the field of pelvis or abdominal cavity. It is the most popular modern procedure For the study of the abdominal cavity.
How is laparoscopy?
Video: How is the laparoscopy and what is "obstruction of pipes"
Indications for laparoscopy
Contraindications for lapovaroscopy
Absolute
Relative
What complications are possible after the procedure?
Complications for this procedure - a rare phenomenon.
What can they be?
Preparation for the operation
Before holding planned operation The patient must pass a certain amount different surveys. As a rule, they are held directly in the hospital, or the patient comes to the department already with full card All required analyzes. In the second case, the number of days must be reduced in the hospital.
Approximate list of surveys and analyzes:
- Coaligram;
- Blood biochemistry (total protein, urea, bilirubin, sugar);
- General analysis of urine and blood;
- Blood type;
- HIV analysis;
- Analysis on syphilis;
- Analysis on hepatitis B and C;
- Fluorography;
- Smear from the vagina on the flora;
- Conclusion of the therapist;
- Ultrasound of a small pelvis.
With existing pathologies from any system of the body, the patient should be consulted by a specialist to assess the presence of contraindications and developing tactics of reference to and after surgery.
Mandatory actions and guidelines to surgery:
Performance and postoperative period
Laparoscopy is not carried out:
- During menstruation (taking into account the risk of raising bloodstures during surgery);
- On the background of sharp inflammatory processes in the body (Herpes, ORZ, etc.);
- Other (described) contraindications.
The optimal time of the operation - from 15 to 25 day of menstrual cycle (with a 28-short cycle), or the first phase of the cycle. The day of operation itself directly depends on the diagnosis.
What can and can not after laparoscopy?
Duration of laparoscopy
- The time of the operation depends on the pathology;
- Forty minutes - when coagulation of foci of endometriosis or separation of adhesions;
- One and a half or two hours - when removing myomatous nodes.
Removing seams, food and sex life after laparoscopy
Stop after the operation is allowed in the evening of the same day. Active lifestyle should be started the next day. Needed:
Pregnancy after laparoscopy
When you can begin to be pregnant after the operation - the question that worries many. It depends on the operation itself, from the diagnosis and on the characteristics of the postoperative period.
When can I go to work?
Based on standards, after surgery, the sick leave is issued for seven days. Most patients are already quite capable of working for this deadline. Exception - work related to severe physical labor.
Advantages and disadvantages of laparoscopy
Pros:
Disadvantages:
- The effects of anesthesia on the body.
Mode after surgery
Real reviews and results
Lydia:
I learned about your endometriosis in 2008, in the same year and operated. 🙂 Today is healthy, pah-pah-pah, so as not to smooth. I myself am then drove in gynecology, and then I was suddenly a patient myself turned out. :) In the ultrasound found a cyst and sent to the operation. I came to the hospital, with anesthesiologist chatted, the analyzes were already ready. After lunch, there was already in operational. It is uncomfortable, I will say, lying naked on the table when there are other people around you. :) In general, I don't remember anything after the anesthesia, but I woke up in the ward. The stomach ached wild, weakness, three holes in a bubbling under the plasters. :) To pain in the stomach, the pain from the anesthetic tube was added. Diar to every day, another day I left home. Then half a year he was treated hormones. Today I am a happy wife and mom. :)
Oksana:
And I was given a laparoscopy because of the ectopic. 🙁 The test constantly showed two bands, and doctors on the ultrasound could not find anything. Type hormonal disbalance You, a girl, do not compost us brains. At this time, the child developed directly in the pipe. I went to another city, to normal doctors. Thank God, the pipe did not break, while he was eager. Doctors have watched and said that the term is 6 weeks. What you say here ... Overlooked. Removed the pipe, the spikes of the second pipe cut off ... Departed after the operation quickly. For the fifth day I went to work. Only the scar on the stomach remained. And in the shower. I can't get pregnant, but I still believe in a miracle.
Alyona:
Doctors put me the ovary cyst and said - without options, only the operation. I had to lie down. For the operation did not pay, they did everything in the direction. For the night - enema, in the morning, the enema, after lunch - the operation. I remember anything, I woke up in the ward. So that there were no sucks, two days were winding the circles around the hospital. :) The hemostatic of the hemostatic drugs, I refused the analgesics, I discharged every other day. Now almost no traces of holes. Pregnancy, truth, for now too. But still had to do. If necessary - then it is necessary. For them, they are young. 🙂
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