Why do my lower limbs become more and more swollen after gynecological surgery?

Many patients who have undergone gynecological surgery find that their legs begin to swell and are sometimes painful. What is going on?

This is deep vein thrombosis of the lower limbs caused by long-term inactivity after surgery. The English name is DVT (deep venous thrombosis). It refers to the formation of blood clots in the venous lumen due to various reasons. It is a venous reflux disorder disease of the lower limbs.

Thrombosis usually occurs during immobilization. The typical clinical manifestation of DVT is swelling and pain in one lower limb (most commonly the left lower limb).

Venous thrombosis and pulmonary embolism are important factors that threaten the life safety of patients during the perioperative period, especially after gynecological surgery, where venous thrombosis is not uncommon. The incidence of thrombosis after gynecological surgery is high and the harm is serious.

Risk factors for thrombosis after gynecological surgery include: age ≥50 years, hypertension, varicose veins, operation time ≥3 hours, postoperative bed rest time ≥48 hours, and laparotomy. Each risk factor is scored as 1 point, and patients are divided into 4 risk levels based on the sum of the scores.

Studies have found that the prognosis of DVT after gynecological surgery is poor, so general prevention of DVT is very important.

Prevention 1: Get out of bed and move around as soon as possible after surgery

Early ambulation after surgery and more rapid resolution of pain and swelling can help reduce the risk of deep vein thrombosis.

Prevention 2: Ankle pump exercise

Regularly performing active exercises while lying on your back, such as ankle flexion and extension exercises, can effectively promote blood circulation and lymphatic return in the lower limbs, reduce inflammation, remove metabolites, and replenish fresh blood.

Prevention 3: Mechanical prevention

Mechanical prevention includes intermittent pneumatic compression (IPC) and gradient compression stockings (GCS). Compared with no preventive measures, IPC can reduce DVT by 56%, and GCS can reduce distal lower limb and asymptomatic DVT by 65%. GCS can reduce distal lower limb and asymptomatic DVT by 65%. Both IPC and GCS should be used before surgery until the patient is free to move after surgery; IPC should be used for at least 18 hours a day.

Prevention 4: Drug prevention

Drug prevention measures mainly include low molecular weight heparin and low-dose heparin.

Expert advice:

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Author: Han Yu, Bi Xia, Zhao Jiangxia

About the Author

Bi Xia

Bi Xia, Doctor of Medicine, Chief Physician, Master Supervisor, is currently the Director of the Department of Rehabilitation Medicine, Zhoupu Hospital Affiliated to Shanghai University of Medicine and Medical Sciences, and the Vice President of the School of Rehabilitation, Shanghai University of Medicine and Medical Sciences. In 2010, 2018 and 2019, she was selected into the Excellent Discipline Leader and Leading Talent Training Program of the Health System of Pudong New Area. She has published 4 SCI papers and more than 30 core journal papers as the first author and corresponding author.

Professional fields: stroke rehabilitation, fracture postoperative rehabilitation, spinal cord injury rehabilitation, artificial joint perioperative rehabilitation, hand injury rehabilitation, etc.

Main academic positions: Member of the Geriatric Rehabilitation Branch of the Chinese Rehabilitation Medicine Association, Member of the Medical and Nursing Integration Committee of the Chinese Rehabilitation Medicine Association, Rehabilitation Committee Member of the Geriatric Rehabilitation Branch of the Chinese Medical Doctor Association, Executive Director of the Shanghai Rehabilitation Medicine Association, Member of the Physical Medicine and Rehabilitation Branch of the Shanghai Medical Association, Vice Chairman of the Rehabilitation Treatment Committee of the Shanghai Rehabilitation Medicine Association, Member of the Orthopedic Rehabilitation Committee of the Shanghai Rehabilitation Medicine Association, Member of the Spinal Cord Injury Rehabilitation Committee of the Shanghai Rehabilitation Medicine Association, Member of the Community Rehabilitation Committee of the Shanghai Rehabilitation Medicine Association, Member of the Sports Health and Rehabilitation Committee of the Shanghai Rehabilitation Medicine Association, Chairman of the Rehabilitation and Physiotherapy Committee of the Shanghai Pudong New Area Medical Association, and other academic positions.

Funded by Shanghai Science and Technology Commission's Science Popularization Project

(Project No.: 20DZ2311100)