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Laparoscopy is a modern surgical technique that is used to diagnose and treat many diseases of the abdominal cavity and genitourinary system. Modern surgery most often uses the laparoscopic method of treatment - it is characterized by minimal trauma, no risk of accidental damage to blood vessels and internal organs, and a short recovery period.

But, as after any other surgical intervention, after laparoscopy some complications may develop, for example, the postoperative suture turns red or a slight compaction appears under it. Should you panic in this case and when should you see a doctor?

Why does a seal appear under the postoperative suture?

The main difference between laparoscopy and conservative surgery is that it does not require traditional penetration into the abdominal cavity. Three small punctures with a diameter of up to 2 cm are made on the front wall of the abdomen, into which surgical instruments are inserted and all necessary surgical manipulations are performed.

After the operation, sutures are placed on the puncture sites, which are removed approximately 6-8 days after the procedure. Special surgical threads can also be used, which have the property of self-absorbing and do not require removal. Accordingly, after laparoscopic surgery, small scars remain, which over time become almost invisible.

Sometimes women notice that after laparoscopy a small seal appears under the suture. Do not be alarmed - this is normal healing of postoperative wounds. After some time, the seal dissolves and the skin acquires a normal color. But at this time, you should strictly follow all the recommendations and advice of your doctor, since after laparoscopy, as after any surgical intervention, the development of adhesions is possible.

What is the adhesive process?

Adhesive disease is a pathological, improper fusion of tissues after surgery. The adhesions themselves consist of scar tissue and can be felt as small, lumpy compactions in the area of ​​postoperative sutures. The adhesive process occurs after any operation and is a natural “companion” of the healing process and scarring of postoperative tissue. Usually the adhesive process goes away on its own and does not require additional treatment.

Adhesive disease, in contrast to natural tissue restoration after laparoscopy, is characterized by abnormal, pathological growth and thickening of connective tissue. Adhesive disease requires special treatment under the strict supervision of the attending physician. To prevent adhesions from appearing in the pelvis after laparoscopy, you should carefully care for postoperative sutures and follow the necessary preventive measures.

Prevention of adhesions after laparoscopy

1. The first thing doctors advise 3-4 hours after laparoscopic surgery is to start moving. Slow walking is an excellent preventive measure that prevents the appearance of adhesions in the pelvic or abdominal area. Active movements prevent pathological fusion of connective tissue and normalize the process of suture restoration.
2. In some cases, drug therapy using anti-inflammatory drugs or antibiotics may be prescribed to prevent adhesions after laparoscopy. Also, to prevent adhesive disease, fibrinolytic medications are used, the main effect of which is aimed at reducing the production of fibrin, a protein substance that acts as the main “building material” for connective tissue.
3. Physiotherapy, which complements one of the above-mentioned preventive methods, shows excellent results in the fight against adhesions. Today, the most effective measures to help prevent the appearance of adhesions after laparoscopy are considered to be electrophoresis and the application of paraffin wax to the operated area.

Caring for sutures after laparoscopy

After discharge from the hospital, it is necessary to carefully care for postoperative sutures. This will help avoid the development of various complications, prevent the development of adhesive disease, and also speed up the process of recovery and tissue restoration.

1. Every day you need to treat the area of ​​postoperative sutures with special antiseptic preparations, which will be recommended by the attending surgeon. You can also use regular brilliant green or iodine. But it should be remembered that no drug should be used without first consulting a doctor.
2. During the first days after laparoscopy, it is not recommended to wash the operated areas. Swimming is allowed only after 10-14 days. For hygiene procedures after surgery, you should not use your usual cosmetic products. Many experts advise choosing regular laundry soap.
3. Many women who have undergone the procedure believe that after the stitches are removed, care for the operated areas of the skin can be stopped. This is absolutely false. You should definitely consult with your surgeon about how long you need to care for your scars. As medical practice shows, antiseptic treatment must be continued for approximately 7 days after removal of the sutures.
4. Approximately 3-4 weeks after laparoscopy, it is allowed to use special absorbable ointments or creams that promote rapid healing of scars and make them less pronounced.

Patients in surgical departments often note the unsatisfactory condition of the postoperative suture. Lumps that are observed in the first days and weeks after surgery usually go away on their own and do not require additional treatment. Most often, this temporary complication looks like a lump on a seam.

Causes

To understand why a lump appeared under the suture after surgery, you should see your doctor. If the lump does not hurt and there is no pus coming out of it, you just need to follow the recommendations for caring for the suture and do not try to self-medicate. If even scanty purulent discharge is detected, it is necessary to consult a doctor. Failure to take action in a timely manner or attempts to resolve the issue on your own can lead to serious complications that can only be eliminated through surgery.

The main causes of suppuration of postoperative sutures:

• Improper care of the seam, which can lead to a bacterial infection.
• Failure to follow the recommendations given by the doctor upon discharge from the hospital.
• Poor quality sutures.
• Rejection by the body of the threads used to stitch the incision.
• Use of low-quality materials.

Whatever the reason for the appearance of a lump after surgery, you should not delay visiting the surgeon in the hope that everything will go away on its own. Suppuration can lead to sepsis and death.

Postoperative complications

They occur after any surgical intervention and vary in severity. It all depends on how carefully the seams were applied and what materials were used. Minor complications go away on their own, but if a bacterial infection occurs during the healing process, the help of a surgeon is necessary. Self-medication is strictly contraindicated due to the complexity of the wound and the risk of sepsis.

The most common postoperative complications:

• adhesive process;
• seroma;
• ligature fistula.

Adhesive process

This is the name for tissue fusion during the healing of a postoperative suture. Adhesions consist of scar tissue and, during palpation, are felt under the skin as small compactions. They accompany the process of healing and scarring of sutures, being an integral, natural step on the path to the restoration of tissue and skin after an incision.

If there is pathology during wound healing, excessive growth of connective tissue is observed, and the suture thickens. Most often this happens if the wound heals by secondary intention, when the process of tissue restoration after surgery was accompanied by suppuration due to an attached bacterial infection. In such cases, keloid scars form at the site of sutures. They do not pose a health hazard, but are considered a cosmetic defect, which can be eliminated later if desired.

Seroma

Another complication that occurs after suturing. A seroma is a fluid-filled lump on a suture. It can occur as a consequence of a cesarean section, or after laparoscopy or any other operation. This complication usually goes away on its own and does not require additional therapy. It occurs at the site of damage to the lymphatic vessels, the connection of which after the incision is impossible. As a result, a cavity is formed that is filled with lymph.

If there are no signs of suppuration, seroma on the scar does not pose a threat to health, but to make sure that there is no inflammatory process, it is worth visiting a surgeon who can make an accurate diagnosis.

Ligature fistula

This complication most often occurs at the suture after a cesarean section. To apply sutures, a special thread is used - a ligature. This material can be self-absorbable or regular. The wound healing time depends on the quality of the thread. If a ligature that meets all requirements was used when suturing, complications are extremely rare.

If an expired material was used or an infection entered the wound during suturing, an inflammatory process develops around the thread. First, a seal appears under the suture after a cesarean or other operation, and after a few months a ligature fistula forms at the site of the seal.

Pathology is easy to detect. A fistula is a non-healing canal in the soft tissues from which pus periodically oozes. Depending on what infection caused the inflammation, the discharge may be yellow, greenish, or burgundy-brown.

From time to time, the wound may become covered with a crust, which periodically breaks open. Purulent discharge can change its color from time to time. Also, the inflammatory process is often accompanied by an increase in temperature and a feeling of chills, weakness, and drowsiness.

A ligature fistula can only be eliminated by a surgeon. The specialist will find and remove the infected thread. Only after this is healing possible. As long as the ligature is in the body, the fistula will only progress. After the thread is removed, the doctor will treat the wound and give instructions for further care of the suture at home.

There are cases when, due to untimely seeking of medical help, several fistulas have formed along the seam. In such a situation, the surgeon may decide to perform an operation to remove the scar and apply repeated sutures.

Precautionary measures

Returning from the hospital, the patient must remember and follow a few simple rules that will help him recover faster after surgery. Basic precautions:

• Do not take a contrast shower. Sudden changes in water temperature slow down the skin regeneration process.
• The shower time should not exceed 10 minutes.
• You can take a bath no earlier than a month after surgery. It is best to additionally ask your doctor about the possibility of this water procedure.
• If a lump appears above the stitch, tell your doctor immediately.

While the patient is in the hospital, his sutures are processed by health workers, but by the time of discharge the patient must learn to handle them independently. If the scar is difficult to access, doctors recommend using the help of relatives or health workers at the clinic.

Any complication is easier to avoid than to treat. To do this, you must follow all the surgeon’s instructions and carefully care for the postoperative wound. As a rule, sutures heal without complications in about a month.

Hello, I had surgery to remove a node in my left mammary gland. Today is the 5th day after surgery and I feel normal. The node is benign. I am worried about the seal near the seam and apparently during the operation the vessels burst and there is a bruise in the shape of a titmouse near the nipple. Please tell me the seal is supposed to be like this? And isn't a bruise scary?

Natalya, Borovichi

ANSWERED: 03/03/2014

Hello, Natalia! In principle, after the operation there may be a thickening of the suture, a hematoma in this area. Sometimes such changes go away on their own, and sometimes you need the help of a doctor. If you are embarrassed by the stitch, I strongly recommend that you see the surgeon who operated it.

ANSWERED: 03/03/2014 Maksimov Alexey Vasilievich Moscow 0.0

The compaction you described could equally well be a variant of the norm (due to surgical intervention) or a sign of the development of a hematoma, seroma, etc. We can only say for sure after an ultrasound.

QUESTION FOR CLARIFICATION 26.03.2014 Danilova, Natalya

Yes, you guys, my ultrasound showed that the seal near the seam is a seroma. Today she was pumped out. The doctor recommended doing a vodka compress for two days as it may become inflamed. He did not prescribe any treatment. And be observed in the future. Maybe you should take some antibiotics for inflammation. But I’m worried about whether the fluid can accumulate again and what complication it can cause? After what time can I do a control ultrasound? Thank you in advance.

ANSWERED: 03/28/2014 Maksimov Alexey Vasilievich Moscow 0.0 surgeon, doctor-maximov.ru

A control ultrasound is performed immediately after the puncture, then on the next day, then after 3-5 days. As for the advisability of taking medications, this is decided strictly individually.

Related questions:

Many patients are faced with the problem of sealing the suture after a cesarean section. Pathology can develop under the influence of various reasons. To determine whether a lump on a stitch is dangerous, a woman should undergo an examination at a medical center. Only after this can a treatment method be selected. You also need to understand that the problem is not always pathological. In many cases, the seal does not pose a threat to the life and health of the patient.

A caesarean section is performed by cutting tissue in the abdominal area. The postoperative incision is sealed with medical materials. The muscle tissue is stitched with a ligature. A silk thread is applied to the skin. The uterus is held together with various materials. The choice of material depends on the type of section and characteristics of the operation. After a cesarean section, a recovery period begins. At this time, the seams should be covered with scar tissue. But the process does not always go smoothly. Some patients complain that the suture turns red after a cesarean section. A lump on the abdomen after a cesarean section may appear for the following reasons:

• development of a purulent process;
• tissue infection;
• use of low-quality material;
• postoperative hematoma;
• autoimmune reaction.

A common cause of suture compaction is a purulent process. Suppuration is observed under the influence of various factors. The process is common due to improper processing of the postoperative field. Damaged tissue is accompanied by the death of some cells. Dead cells accumulate on the surface of the wound. To enhance healing, the incision is coated with white blood cells. The mixing of dead tissue, white blood cells and dead skin particles leads to the formation of pus. Pus causes inflammation of the suture. The tissues begin to thicken.

A seal occurs on the suture after a cesarean section due to infection. Many infections depend on the activity of pathogenic microorganisms. Bacteria can enter the wound during poor-quality surgery or after cesarean with infrequent treatment. Pathogenic microorganisms multiply rapidly and cause changes in tissue structure. Bacteria feed on tissue cells. The area of ​​tissue affected by pathogenic microbes becomes inflamed. The worsening of the process is accompanied by compaction. A woman discovers lumps on her wound. Bacterial infection is also determined by additional signs. The patient notices severe burning and itching. An ichor may appear on the surface of the seam. In order for the doctor to quickly select effective treatment, it is necessary to undergo additional examination.

Additional factors

The suture after a cesarean section may become thicker if low-quality medical material is used. The seal appears due to expired threads. This material causes a seal to form. To get rid of the problem, repeated surgery should be performed.

In the first days after a cesarean section, a lump forms due to a hematoma. Hematoma after cesarean section is a common problem. The bruise appears due to internal bleeding. The area of ​​the abdominal region where there is a bruise is hard and dense on palpation. This problem does not require additional intervention in most patients. A few days after surgery, it resolves.

An autoimmune reaction rarely occurs in women. It is impossible to determine the disease in advance. The pathology is characterized by the rejection of medical material by the human body.

For unknown reasons, the body perceives the threads as a foreign body. This leads to the appearance of antibodies in the blood. These are special particles designed to capture foreign microorganisms. The response of the autoimmune system is unpredictable. This problem can only be solved by selecting another material or prescribing a drug to eliminate the activity of the system.

Formation of postoperative fistula

Ligature fistulas are a common problem after surgery. Pathology gradually appears in the muscle layer of the abdominal cavity. The problem got its name because of the peculiarities of its occurrence. The culprit of the disease is a ligature that is not completely decomposed. The threads on the muscle layer should completely decompose within a few weeks after a cesarean section. But under the influence of various negative reasons this does not happen. Part of the ligature is retained in the abdominal area.

The ligature causes inflammation in the damaged tissue. The process is accompanied by the death of cells in the muscle layer surrounding the thread. Dead cells accumulate on the surface of the ligature. The body responds to pathology by producing large numbers of white blood cells. Together with the tissue, leukocytes form pus.

Suppuration causes further death of the layers of the abdominal cavity. The problem cannot be detected immediately. The woman notices that a small bump appears on the surface of the stitches.

The compaction is accompanied by the appearance of a slight swelling similar to a boil. Some time after the operation, a purulent head forms on the top of the tumor. The skin is torn. Pus begins to drain from the fistula canal.

Ligature fistula is accompanied by additional symptoms. A woman should pay attention to the following signs:

• throbbing pain in the suture area;
• redness of the skin;
• a feeling of fullness in the scar area.

The main sign of developing internal suppuration is throbbing pain in the suture area. Throbbing pain occurs due to the gradual death of tissue. You should also pay attention to the feeling of scar tissue swelling. This is also provoked by purulent fluid.

The doctor makes the diagnosis after initial treatment of the fistula canal. An antiseptic solution is injected into the lumen. Hydrogen peroxide has a good effect. Peroxide breaks down the pus and removes it from the canal. After thoroughly cleaning the fistula, the doctor examines the cavity. A ligature residue is found in the muscle layer. You cannot leave material in the channel. It will cause further tissue destruction.

Treatment is carried out through surgery. The doctor removes the remaining threads from the canal. A new suture is not placed on the wound. After the intervention, the woman remains in hospital treatment. This is necessary to further monitor the healing rate. It is also necessary to ensure that a new fistula does not form.

Neoplasm with lymph

A lump over the incision after a cesarean section may form due to the formation of a lymphatic cavity. This occurs against the background of dissection of the lymphatic channels.

All layers of tissue are nourished by the lymphatic system. During a caesarean section, several layers of tissue are cut. The channels are also damaged. After the operation, the tissues are held together with threads. Lymphatic channels and vessel walls remain damaged. In most women, the vessels and canals heal on their own. In some cases, the internal lymphatic channel does not heal. The liquid that moves through the channel enters the free space. A small cavity filled with lymph is formed in the peritoneum.

This tumor is called seroma. To determine its presence, you need to pay attention to the following signs:

• round growth on the skin;
• redness of the skin in the affected area;
• burning sensation.

The main sign of seroma is the formation of a round, red growth on the skin. In most cases, seroma does not require treatment. She is able to heal on her own. If the seroma persists for a long time, it is necessary to open the surface of the seroma and release excess lymph. The wound is washed with a solution of chlorhexidine or sterile liquid furatsilin. Gradually the damage will heal on its own.

Uncharacteristic scar tissue

The suture after a cesarean section may become thicker for other reasons. The surface of the wound after surgery is covered with a thin film, which forms a scar. Normal scar tissue should not rise above the skin. Immediately after formation, the tissue is red in color. After some time, the seam brightens and becomes less noticeable to others. But sometimes the scar does not form correctly. Under the influence of negative factors, rumen cells begin to actively multiply. A keloid scar forms on the wound. The causes of a keloid scar are as follows:

• previous infection;
• disruption of the update process.

Keloid tissue cannot harm the patient's health. A psychological problem arises. The scar spoils the appearance. Doctors recommend treating keloid scars using cosmetic techniques.

A hard scar can be eliminated with a laser. The laser beam has a warming effect on the tissue. She is melting. A burn forms on the scar. It is not recommended to remove the burn crust yourself. It should disappear completely after some time.

You can resort to grinding. The working surface of the grinding apparatus rotates at high speed. Under the influence of friction, the convex part of the scar is gradually eliminated. Several treatments may be needed to achieve a good result.

Preventive measures

To avoid problems, you must follow your doctor's advice. To get a good result, you need to properly postpone the recovery period. The first days after a cesarean section, you need to follow the rules for processing the incision. The sutures are processed by medical personnel for several days. The procedural nurse can teach the patient how to cleanse the wound independently. In order for the sutures to heal correctly, it is necessary to use an antiseptic solution and a drying agent.

Initially, the seam is washed with an antiseptic liquid. Processing is carried out until the contaminants are completely removed. After removing the crust, the edges of the wound should be lubricated with a drying agent. For this purpose, you can use brilliant green or fucorcin. Treatment must be carried out at least once a day. This will help prevent the development of infection or inflammation.

It is also necessary to seal the surface of the suture with a postoperative dressing. Bandages can be purchased at a pharmacy. Manufacturers offer a large selection of dressings from various materials.

After the formation of thin scar tissue, a woman should closely monitor her health. The following should cause concern:

• the appearance of redness around the seam;
• the appearance of blood or ichor from the wound;
• changes in the characteristics of vaginal discharge;
• pain in the incision area.

Redness of the tissues surrounding the sutures may be due to the development of inflammation or infection of the wound. The appearance of blood and ichor from the wound a few weeks after a cesarean section is dangerous. This phenomenon can occur during the initial form of suppuration.

Caesarean section is a difficult and traumatic operation for a woman. After surgery, it is recommended to carefully monitor the characteristics of the suture. If palpation reveals a hard scar, you should visit a doctor. The specialist will determine the cause of the compaction and select an effective treatment.

After a caesarean section, the main complaints of patients concern the condition of the suture. Complications can arise for various reasons. The most common complication is considered to be a seal at the seam, but this complication is not always dangerous and in most cases does not require additional treatment. In order to understand whether a lump is dangerous or not dangerous, you need to consult a surgeon. Self-treatment can only worsen the situation and lead to the need for urgent surgical intervention.

Danger signs

Among the dangerous signs of a developing complication after a cesarean section, one can highlight compaction and suppuration of the sutures. This is a fairly common phenomenon that is noticeable to the naked eye when examining the seams. Problems with seams can arise for various reasons, including:

• suture infection,
• low quality suture material,
• insufficient qualification of the surgeon,
• rejection of suture material by the woman’s body.

Every woman should understand that the suture must be carefully monitored for several months after surgery, and if phenomena such as induration, pain, redness or suppuration are detected, it is necessary to immediately seek advice from a surgeon.

Ligature fistula

This complication is the most common after cesarean section. After the operation, the incision is sutured using special threads - ligatures. These threads can be absorbable or non-absorbable. The healing time of the scar depends on the quality of the ligature. If the material was of high quality, used within the acceptable expiration dates, in accordance with the norms and rules of treatment, complications are unlikely.

But if the ligature was used after the specified expiration date or an infection got into the wound, an inflammatory process begins to develop around the thread, which can form a fistula several months after cesarean.

A fistula is very easy to detect. It has such signs as a non-healing wound, from which a certain amount of pus is periodically released. The wound may crust over, but then it opens again and pus is released again. This phenomenon may be accompanied by elevated body temperature, chills and general weakness.

Length of hospital stay after caesarean section

If a fistula is detected, the help of a surgeon is necessary. Only a doctor can detect and remove an infected thread. Without removing the ligature, the fistula will not go away, but will only increase. Local treatment will not bring positive results. After removing the thread, the suture requires additional care, which will be prescribed to you by the surgeon.

If the infection process is prolonged, or several fistulas have formed on the scar, surgery may be required to remove the scar with repeated stitches.

Seroma

Seroma is also a common complication after cesarean section. But unlike a ligature fistula, this complication can go away on its own, without additional treatment. A seroma is a fluid-filled lump on a suture. It occurs at the intersection of lymphatic vessels, which cannot be sutured after the incision. At the intersection of lymphatic vessels, a cavity is formed that is filled with lymph.

Without additional dangerous signs, seroma does not require treatment and goes away on its own within a few weeks.

If a seroma is detected, you should immediately visit a surgeon to determine an accurate diagnosis and exclude suppuration.

Keloid scar

Another most common complication after cesarean section is the formation of a keloid scar. Recognizing it is also not difficult.

The seam becomes rough, hard and often protrudes above the surface of the skin.

There is no pain, redness around the scar or pus.

A keloid scar does not pose a threat to the health of patients and is only an aesthetic problem. The causes of scar formation are considered to be individual characteristics of the body.

Today there are several methods of treating this unsightly phenomenon:

1. Laser therapy is based on resurfacing the scar using a laser. Several therapy sessions can make the scar less noticeable.
2. Hormonal therapy includes the use of special medications and ointments containing hormones. Using creams will help reduce scar tissue and make the scar less pronounced.
3. Surgical treatment consists of complete excision of scar tissue followed by the application of new sutures. This method does not guarantee that a normal scar will form at the site of the removed scar.

When can a woman take a bath after a caesarean section without the risk of complications?

In order to avoid all these and other complications in the postoperative period, it is necessary to carefully care for the suture and follow all doctor’s recommendations. If any signs of complications appear, visit your doctor immediately, in this case you can avoid surgical treatment.