Uterine laparotomy consequences. Laparotomy in gynecology: what it is and how it is performed

This surgical version of the operation, called laparotomy, is often used in gynecological practice, and it consists of open access to organs that are located in the pelvic area, it is carried out by creating a small incision in the abdomen.

When is laparotomy possible?

This treatment method, called laparotomy, is used for:

• manifestations of ovarian cysts, which are also called cisectomy;
• during the process of removing myomatous nodes, which is called myectomy;
• during extirpation of the uterus along with its appendages;
• during surgical treatment of endometriosis;
• during caesarean section.

At the time of laparotomy, it often happens that surgeons notice various pathological conditions, which are expressed by: inflammation of the organs that are located in the pelvic area, as well as inflammation of the appendix, called appendicitis; ovarian and even uterine appendage cancer is also often diagnosed; formed adhesions are noticed in the pelvic area. Laparotomy can often be used when women develop ectopic pregnancies.

Different types of laparotomy

Today stand out different kinds laparotomy:

Let's consider the process of performing the operation using the path of the lower connecting incision. To do this, an incision is made, which is created on the basis of a line that runs exactly in the area between the navel itself and the frontal part of the bone. This method of performing laparotomy is quite often used to treat tumor diseases, which most often occurs with manifestations of uterine fibroids.

An important advantage of this particular method is that it will be very convenient for the surgeon, because he will be able to create an expansion of the incision at the right time, due to which it will be possible to create an increase in access to various bodies, as well as fabrics.

At the same time, the process of Laparotomy based on Pfannenstiel is considered the main method that is currently used in gynecology. The incision itself is created based on the lower line of the abdomen itself, which will create a completely camouflaged appearance of this incision, while it will not be almost visible after it has healed, although there will be a scar, but it will be almost invisible.

Main advantages

The main advantages of laparotomy include:

• technical simplicity of this operation;
• the operation does not require the use of very complex instruments;
• this operation is very convenient for the surgeon himself who carries out the process surgical intervention during the course of the disease.

Existing differences between laparotomy and laparoscopy

Most women often think that these two different versions of surgical techniques are very similar. But the main differences between these two operations are that the process of laparoscopy is created mainly for diagnosis, but laparotomy is already a real method of real surgical intervention, which accompanies various removals or excisions of an organ that has pathology, or we can talk about tissues.

At the same time, during a laparotomy on the body of a woman, a noticeable large incision is often made, after which a fairly noticeable suture remains, while during laparoscopy there is usually only a small wound left, which will heal within 1 - 1.5 weeks.

Depending on the choice of whether to perform laparotomy or laparoscopy, the very timing of future rehabilitation will depend. After the laparotomy process, the rehabilitation process can take several weeks and can last up to one month, but after laparoscopy the patient will be able to return to his normal life within 1 - 2 weeks.

What are the consequences of laparotomy and its possible complications?

After this type of intervention in the course of the uterine disease, in the form of uterine laparotomy, collateral damage to adjacent organs of the entire pelvis may occur. The risk of various adhesions also increases markedly.

This process can occur due to the fact that during the operation, various surgical elements may come into contact with the peritoneum itself, due to which it can subsequently become noticeably inflamed and noticeable adhesions can form on it, which can, as it were, “glue” the organs together directly together.

At the same time, during laparotomy processes, such an unpleasant complication as bleeding may occur. This phenomenon can be caused by various ruptures or damage to organs in the form of ruptures fallopian tubes, at possible holding abdominal surgery. If this really manifests itself, then this entire organ will have to be removed, which can ultimately lead to the process of infertility.

When can you plan a pregnancy after laparotomy?

This may depend on which organ out of all reproductive system underwent surgical intervention, and the general time frame for the possibility of becoming pregnant may vary because of this. Although it is generally not recommended to make plans to become pregnant, you will have to wait about 6 months after this surgery.

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The operation of laparotomy is also called transection. When performing it, the abdominal cavity is opened, thereby organizing access to the internal organs. This surgical intervention is performed if there is a suspicion of pathological processes in the stomach, requiring emergency care. These include:

• Inflammation of the appendix;
• Ectopic pregnancy (especially with ruptures);
• Perforated intestinal ulcers;
• Suspicion of peritonitis;
• Oncological processes in abdominal cavity;
• Traumatic injuries internal organs;
• Endometriosis, ovarian cyst and other gynecological diseases.

Basic requirements for laparotomy access:

1. Lowest possible morbidity;
2. Preserving the integrity of muscles, blood vessels and nerves;
3. Sufficient space for manipulation and assessment of the condition of the organ;
4. Possibility of effective stitching of dissected layers;
5. Does not increase the risk of hernia formation.

A separate category is diagnostic laparotomy, which is performed when the diagnosis has not yet been confirmed and the doctor needs to confirm or exclude a particular pathology. Indications for it are suspicions of conditions, the failure to identify which will lead to irreversible consequences or death of the patient.

Distinguish 5 main types surgical intervention, each of which has its own indications, advantages and disadvantages.

The choice of a particular type is based on individual characteristics patient and reason for surgery.

The most commonly used operation is considered to be a median laparotomy, which is also divided into several options:

1. Upper middle. For upper midline laparotomy, the incision starts from xiphoid process sternum and continues to the umbilical cavity. In this way, the surgeon gains access to the upper floor of the abdominal cavity and its organs. Among the main advantages of this type of dissection are speed (which is important in urgent situations), the possibility of extending it downwards if more extensive access is required, and simple suturing. However, this approach involves cutting the muscle tendons, which ultimately leads to an increased risk of hernia formation.
2. Lower middle. With a lower median laparotomy, an incision is made from the navel and ends at the symphysis pubis. The advantages of this approach, as well as the disadvantages, completely coincide with the previous one, the only difference is that through this dissection the surgeon has the opportunity to evaluate the lower floor of the abdominal cavity and its organs.
3. Central median. The incision with this type of laparotomy begins 8 cm above the navel, reaches it, bypasses the formation on the left and then descends 8 cm below. Most often it is used for diagnostics, so that after assessing the condition of the organs of the cavity, either suturing it or extending it to the damaged organ, that is, above or below. The main advantage is that if the alleged diagnosis is not confirmed, there will be minimal unnecessary trauma.
4. Total. It is used very rarely and only for clear indications, for example, multiple abdominal injuries. The incision is made from the xiphoid process and continues to the symphysis pubis. In this case, the anterior abdominal wall is weakened as much as possible, and postoperative sutures often diverge. But the surgeon has free access to all organs of the cavity, which is especially important in case of combined injuries.

In addition to the median laparotomy, paramedian laparotomy is also distinguished. It is characterized by dissection of layers along the inner edge of the rectus abdominis muscle, thereby forming strong postoperative scars that do not weaken the abdominal wall. The transrectal type of operation involves an incision above the rectus muscle, during which its fascia is cut and then the fibers are separated. The operation is performed according to clear indications, most often to create fistulas. Pararectal laparotomy is analogous to paramedial laparotomy, but the incision is made not along the inner, but along the outer edge of the muscle. The incision can be used for diagnosis inflammatory process in the appendix.

Oblique laparotomy

The incisions can be upper, that is, along the edge of the costal arches, or lower, along inguinal ligaments. With their help, the surgeon gains access to specific organs: the gallbladder, appendix, spleen. The main disadvantage of incisions is their limitation, especially if complications arise or additional problems are discovered.

Transverse dissections

Such incisions involve cutting muscles and are therefore rarely used. They provide convenient access to the pelvic organs and are most often used in gynecology, for example, laparotomy for ovarian cysts. Due to muscle damage after such approaches, the abdominal wall is weakened and the risk of hernias increases.

Angled laparotomies

They are used for more convenient access to certain organs. For example, if it is necessary to get to the liver and gallbladder ducts, then a longitudinal incision along the upper floor is turned along the costal arch on the right.

Progress of laparotomy operation

First of all, anesthesia is administered. Most often, abdominal operations, including laparotomy, are performed under general anesthesia.

• First, an incision is made in the skin and subcutaneous fat. After the dissection, the resulting wound is drained and the blood vessels are clamped, and only then the next stage is started.
• Using special instruments for laparotomy - hooks, the edges of the wound are pulled apart so that the surgeon can cut the aponeurosis. In some cases, in addition, to improve visibility, it is necessary to remove the muscles blocking the doctor’s view with the edge.
• The third stage is to dissect the peritoneum with special scissors, after first picking it up with tweezers. If there is a liquid of any kind in the cavity, it will splash out under pressure. The surgeon's assistant should be prepared for this situation and use a special suction.
• After all layers have been dissected, the edges of the wound are spread apart with expanders, and the surgeon conducts a thorough examination of all organs, even if a specific pathology was suspected, each organ to which there is access is assessed.
• After identifying the problem, the operation itself is performed, during which the patient’s condition is normalized, the functioning of the damaged organ is restored as much as possible, and if this is not possible, it is removed.
• After completion, drainage is installed and the dissected area is sutured layer-by-layer.

Recovery after surgery

In order to avoid negative consequences or complications, certain instructions must be followed during recovery from laparotomy. Requirements for patients in a hospital setting:

1. Compliance with all doctor's instructions;
2. Using special shoes to reduce the risk of blood clots;
3. Urination through a catheter (not always required, but often);
4. To improve breathing, an incentive spirometer may be installed (used in difficult situations);
5. The patient should not disturb the wound, remove the bandages or touch the drains on their own to avoid infection.

The length of hospital stay depends entirely on the disease being treated through surgery and the severity of the patient's condition. At home, you also need to follow some rules:

• Compliance with all doctor’s recommendations and regular visits to the hospital on time;
• Maintaining maximum hygiene in the wound area;
• Water should not be allowed to get into the postoperative wound;
• Physical activity should be minimal;
• Do not lift heavy objects (the seams may come apart);
• A diet high in vegetables and fruits.

Sutures are often removed a week after surgery, but the timing depends on the extent of the incisions and the speed of wound healing. However, in postoperative period you should be extremely attentive to your condition. The appearance of some symptoms may be the basis for immediate appeal to the doctor. These symptoms include:

1. Increased temperature (both general and local in the wound area);
2. The appearance of discharge in the operated area or the formation of signs of inflammation;
3. Abnormal bowel movements lasting more than 3 days;
4. Changes in the properties of stool (especially coffee-ground-colored stool);
5. Violation general condition(dizziness, weakness or even fainting);
6. Nausea, sometimes with vomiting;
7. Problems with urination;
8. Redness, swelling, or appearance painful sensations in the lower extremities.

These symptoms indicate complications and therefore require immediate evaluation by a doctor and appropriate treatment.

Complications after laparotomy

Any postoperative complications They occur quite rarely, but they can still happen. Their risk increases in the presence of certain predisposing factors:

• Repeated intervention;
• Diabetes;
• Low body resistance (immunodeficiency, exhaustion);
• Having bad habits;
• Diseases of the cardiovascular and respiratory systems;
• Blood pathologies (low coagulability, increased viscosity and others);
• Use of certain medications.

The main complications after laparotomy in gynecology are: acute abdomen and other serious pathologies:

• Bleeding (can be external, but most often internal, difficult to diagnose);
• Infection in a postoperative wound or even in the peritoneal cavity;
• Increased thrombus formation;
• Injury to neighboring organs;
• Allergic reaction to anesthetic drugs;
• The appearance of hernias due to weakness of the anterior abdominal wall.

The risk of complications after surgery directly depends on the qualifications and experience of the surgeon. However, in some situations, in particularly severe conditions or with combined pathologies, complications are almost inevitable.

Laparotomy is quite complicated surgery, which requires the specialist performing it to have special knowledge of anatomy and skills in using surgical instruments.

Types and features of holding

What is laparotomy in surgery? The following methods of transection are distinguished.

Median laparotomy, in turn, is divided into the following types:

• Upper median laparotomy - features: the beginning of the section is from the urinary process of the sternum to the umbilical cavity. The surgeon gains access to organs/tissues located in the upper part of the peritoneum. The advantages of this method: speed, easy cutting/suturing, possibility of extending the incision line if necessary. Disadvantage: upper midline laparotomy involves cutting the tendons, and this is fraught with the formation of hernias;
• Inferomedian laparotomy - the incision begins at the navel and ends near the symphysis pubis. The surgeon gets the opportunity to assess the condition and take measures to eliminate pathologies of the tissues and organs of the lower part of the peritoneum. The pros and cons of this method are similar to the upper median laparotomy;
• What is central midline laparotomy in surgery? The incision begins at a distance of eight cm above the navel, then goes to it, goes around on the left side, and goes down 8 cm. This method is used when it is necessary to suturing internal organs for a more accurate diagnosis;
• Total laparotomy is used in surgery quite rarely. Indication: multiple abdominal injuries. The line of dissection is from the urinary process to the symphysis pubis;

Oblique incision - the dissection is made from below along the edge of the rib arches or from above along the groin ligaments. It opens access to the appendix, spleen, gall bladder;

Transverse excision involves cutting the muscle fibers. Often used in gynecology. There is a risk of postoperative hernias due to weakening of the peritoneal wall;

Angular transection is prescribed if it is necessary to “get” to certain body: gallbladder ducts, liver.

The type of surgical intervention is prescribed by a specialist depending on the type of disease.

The role of laparotomy in the diagnosis of diseases of the abdominal cavity

Diagnostic laparotomy (explorative) is currently not so frequent and widespread in medicine. The reason is the presence in clinical practice of a sufficient number of high-precision research methods: ultrasound, computed tomography, x-rays, radiation diagnostics.

Diagnostic laparotomy: causes - damage to the abdominal organs, acute surgical diseases, the inability to establish the disease using invasive methods and prescribe treatment methods.

For what pathologies is diagnostic laparotomy still prescribed:

• Perforation, injuries of the stomach, duodenum, colon, pancreas, ureter, kidneys, vessels of the retroperitoneal space;
• Ulcer in acute/chronic form;
• A cancerous tumor is in the decay stage;
• Tuberculosis;
• Necrosis;
• Fecal stones;
• Internal hernias;
• Peritonitis.

Diagnostic laparotomy allows you to detect benign and malignant tumors, ulcers.

Exploratory laparotomy is a manipulation that requires preliminary preparation. Specialists determine the plan and progress of work in advance, assess the risks, and take measures to reduce them. Its duration, as a rule, does not exceed two hours, with heavy bleeding- no more than twenty to thirty minutes.

It is important to ensure during surgery external breathing patient, stabilize systolic pressure, monitor urine output using a catheter.

Requirements for laparotomy

• The risks of hernia formation are minimized; post-traumatic conditions, complications;
• Muscles, nerve endings, blood vessels are intact;
• The surgeon must have a place for excision, assessing the condition of organs, systems, tissues, performing manipulations, and stitching the cut layers.

The operation is carried out using general anesthesia. Step one – the skin and subcutaneous fat are cut. The wound is dried using napkins attached to cleols or clamps along the edges, the vessels are clamped. Step two - the edges of the wound are spread apart using hooks, opening the view. Step three - dissection of the peritoneum with special scissors. Often on at this stage the liquid contained in the cavity splashes out. A special pump is used to suck it out. Step four - specialists carefully examine the opened organs, identify pathology, eliminate it, returning the organs and tissues to normal functioning, and if this is not possible, remove them. Step five - drainage is installed, then the incised area of ​​the peritoneum is sutured in layers. Diagnostic laparotomy is performed in a similar way.

• Compliance with all recommendations and prescriptions of the doctor;
• Wearing shoes that reduce the risk of blood clots;
• Using a catheter when urinating;
• Eating easily digestible foods, vegetables, fruits, juices;
• The most important thing is that you should not touch a fresh wound, get it wet, or pick it with your fingers or sharp objects to avoid infections;
• Intensive activities after abdominal surgery are not acceptable physical exercise and exercises;
• Monitoring your health status: body temperature, timely urination, stool. You should immediately contact medical care in case of dizziness, nausea, fever, pain, bleeding in the wound area.

Transsection in gynecology: features, types, differences from laparoscopy

Laparotomy in gynecology is a fairly common occurrence. It is prescribed in the following cases:

• Ectopic pregnancy;
• Cysts, purulent inflammation uterine tubes, ovaries;
• Peritonitis;
• Ovarian pathologies;
• Infertility;
• Obstetrics (caesarean section).

A similar procedure is also necessary when the patient requires medical indications complete removal– extirpation of the uterus with appendages.

Laparotomy is often confused with another surgical procedure – laparoscopy. How do they differ from each other?

Important: to perform the operation there is no need to cut the peritoneum - the surgeon makes several minor punctures through which manipulations are carried out, cameras and instruments are inserted.

Methods of abdominal dissection during gynecological operations:

• Cherny dissection - an incision is made along the line between the navel and the pubic bone. Used for uterine fibroids.
• Laparotomy according to Pfannenstiel with a transverse incision above the pubis, along the lower line of the abdomen.
• Laparotomy according to Joel Cohen - transverse excision below the middle of the distance from the navel to the pubis by two to three cm.

Laparotomy of women reproductive organs– the procedure is unsafe, fraught with complications, functional disorders, and long tissue restoration. However, it is often the last chance for patients with malignant tumors and metastases. Laparotomy of the uterus is carried out after preliminary preparation and thorough examinations, including ultrasound, histological studies, hysterocerviscopy, magnetic resonance and computed tomography. Laparotomy of an ovarian cyst is necessary in cases of formations of significant size in the deep tissues of the ovaries, purulent processes, torsion of neoplasms, adhesions in the pelvic organs, the presence of cancer.

Recovery after laparotomy of an ovarian cyst is a process that requires adequate treatment and observation: hospital stay for four days from the day of surgery, regular medical examination, prescription and use of painkillers. During the month after surgery, intense physical activity and physical education are strictly contraindicated.

Does pregnancy occur after laparotomy? The chances of pregnancy and a successful delivery in patients who have undergone it are quite high. When can you get pregnant after surgery? Answer to this question will be given by the specialist under whose supervision the woman was. He will give recommendations on timing based on severity past illness, features of the operation, recovery period, rehabilitation. It is recommended not to conduct the first two months after surgery. sex life, and they advise getting pregnant after six months.

What to do if pregnancy does not occur after a year or more? Go to the hospital, go additional research and prescribed treatments.

Complications after gynecological surgery:

• Excess weight;
• Chronic diseases;
• Bad habits: alcohol, drug addiction, smoking, non-compliance with the daily routine, nervous tension;
• Diseases of the respiratory and cardiovascular systems;
• Pathologies circulatory system(incoagulability of blood, viscous, thick blood);
• Repeated surgical procedures;
• External and internal bleeding;
• Tendency to form blood clots;
• Hernias.

Where can I find out more about the operation? Modern special means mass media, literature, specialized websites provide complete and comprehensive information about this surgical procedure.

A surgical method of operation such as laparotomy, often used in gynecology, is an open access to organs located in the pelvis, and is carried out through a small incision in the abdomen.

Laparotomy is used for:

• ovarian cysts – cisectomy;
• removal of myomatous nodes - myectomy;
• surgical treatment endometriosis;
• caesarean section.

When performing laparotomy, quite often surgeons diagnose various kinds of pathological conditions, such as: inflammation of organs located in the pelvis, inflammation of the appendix (appendicitis), cancer of the ovaries and uterine appendages, the formation of adhesions in the pelvic area. Laparotomy is often used when a woman experiences this.

There are several types of laparotomy:

1. The operation is performed through a lower midline incision. In this case, an incision is made along the line exactly between the navel and the pubic bone. This method of laparotomy is often used for tumor diseases, for example, with uterine fibroids. Advantage this method is that the surgeon can expand the incision at any time, thereby increasing access to organs and tissues.
2. Pfannenstiel laparotomy is the main method used in gynecology. The incision is made along the lower line of the abdomen, which allows it to be completely camouflaged and after healing, the remaining small scar is almost impossible to notice.

The main advantages of laparotomy are:

• technical simplicity of the operation;
• does not require complex tools;
• convenient for the surgeon performing surgery.

Many women often identify 2 different surgical method: laparoscopy and laparotomy. The main differences between these two operations are that laparoscopy is performed mainly for diagnostic purposes, and laparotomy is already a method of direct surgical intervention, entailing the removal or excision of a pathological organ or tissue. Also, when performing a laparotomy, a large incision is made on the woman’s body, after which a suture remains, and during laparoscopy, only small wounds remain, which heal after 1-1.5 weeks.

Depending on what is being performed - laparotomy or laparoscopy, the rehabilitation period is different. After laparotomy it ranges from several weeks to 1 month, and with laparoscopy the patient returns to normal life after 1-2 weeks.

When performing this type of surgery, such as laparotomy of the uterus, damage to adjacent pelvic organs is possible. In addition, the risk of adhesions after surgery increases. This happens because during the operation, surgical instruments come into contact with the peritoneum, as a result of which it becomes inflamed and adhesions are formed on it, which “glue” the organs together.

During laparotomy, complications such as bleeding may occur. It is caused by rupture or damage to organs (rupture of the fallopian tubes) during abdominal surgery. In this case, it is necessary to remove the entire organ, which will lead to infertility.

When can you plan a pregnancy after laparotomy?

Depending on which organ of the reproductive system underwent surgical intervention, the time frame after which you can become pregnant varies. In general, it is not recommended to plan a pregnancy earlier than six months after the laparotomy.

Laparotomy– surgical opening of the abdominal cavity, the purpose of which is internal examination, diagnosis of gynecological and other pathological changes, including surgical intervention.

It should be emphasized laparotomy quite often indicates such pathological phenomena as appendicitis, inflammation and adhesions in the pelvic area, pregnancy outside the uterus, malignant tumor ovaries.

Laparotomy used in the treatment of endometrosis, excision of adhesions, the possibility of removal surgically uterine fibroids, ovaries (oophorectomy), appendix, as well as the surgical actions of the surgeon to restore the patency of previously ligated uterine tubes.

Due to laparotomy- these are the surgical actions of the surgeon associated with potential risk, medical specialists prefer to first perform laparoscopy, which is the least traumatic diagnostic method and treatment of certain pathological disorders in organism.

How are laparotomies prepared?

Before the surgeon’s surgical actions, the following methods are performed medical examination:

Conduct a physical examination of the patient.

They do a general analysis.

Ultrasound examination.

A computed tomography scan is performed.

During the week before the procedure, stop taking the following: medicines:

Anti-inflammatory drugs (aspirin, etc.).

Medicines and blood thinners.

The day before laparotomy, they refuse to eat.

Diagnosis by laparotomy

In the diagnosis of emergency laparotomy, abdominal surgical procedures involve symptoms acute diseases or damage to internal organs, taking into account that in the previous diagnosis (invasive measures inclusive), they could not confidently exclude pathological changes body.

Similar diagnostic difficulties can be observed in cases of extraperitoneal trauma or perforation, for example:

Duodenum.

Pancreas.

Stomach.

Large blood vessel.

The reason for perforation of the septum of a hollow organ of the extraperitoneal cavity is:

Chronic peptic ulcer disease.

Acute peptic ulcer disease.

Tuberculosis.

Large foreign body.

Fecal stone, which causes bedsores of the wall.

Thromboembolism of branches in the mesethereal artery causing limited necrosis.

Indications for diagnosis by laparotomy, may also become an infectious problem after laparotomy inside the abdominal cavity.

Difficulty in detecting early peritonitis after surgical interventions are explained under the following circumstances:

Serious condition patient.

Incorrect perception of the disease, resulting from a degenerative disorder of the receptors, as well as the abdominal nerve plexuses.

Leveling clinical signs due to medication therapeutic action(for example, analgesics).

An atypical course with minor symptoms is peritonitis after surgery in mature, anemic patients who have mental disorders.

Recognizing such a threat to life human body complications are based on a number of specific criteria:

Long-term postoperative paresis.

Reduced effectiveness of drug stimulation.

Increasing intoxication.

Fading of intestinal peristalsis after a restorative procedure.

Increased inflammation in the blood.

Paralytic variant of intestinal obstruction.

The above symptoms are observed in the terminal and also toxic stages of peritonitis, that is, they have a long period of development.

Urgent diagnosis by laparotomy optimizes detection of peritonitis after surgery by a surgeon in the initial development process.

Assumption cancerous tumor in the peritoneum, if it is impossible to exclude suspicion by other means, also has a solid indication for diagnosis by laparotomy.

Complication

Bleeding.

Hernia formation.

Infection.

Injury to internal organs during surgery.

Big scar.

Negative response of the body to anesthesia.

Circumstances that increase the risk of complications:

Previous surgical actions of the surgeon in the peritoneal cavity.

Heart and lung diseases.

Diabetes.

Weak immune system.

Failure of the circulatory system.

Use of certain medications.

Abuse of habits negative for the body (alcohol, smoking, etc.).

Rehabilitation period

To prevent blood clots, use special clothing.

A catheter is used for difficulty urinating.

A spirometer is used to stimulate breathing.

Compliance with the instructions of medical specialists.

Staples and stitches are removed within ten days.

Limit physical activity.

Eat more vitamins.

Try to avoid constipation (take laxatives if necessary).

To drink a lot of water.