METHOD OF SURGICAL TREATMENT OF ANTERIOR VAGINAL WALL PROLAPSE IN WOMEN WITH HIGH RISK OF RELAPSE AFTER EXTIRPATION OF UTERUS Russian patent published in 2013 - IPC A61B17/42 A61F2/02 

FIELD: medicine.

SUBSTANCE: invention relates to operative gynecology and can be applied in treatment of women with anterior vaginal wall prolapse with high risk of relapse after extirpation of uterus. For this purpose transvaginal access is realised. Longitudinal cut of vagina mucous membrane, with 2.5-3 cm indent proximally from external urethra orifice is performed. Not only vagina mucous membrane but also underlying fascia is dissected to reduce risk of erosion development in post-operative period. After that, reconstruction of anterior and apical parts of pelvic floor is carried out. For this purpose four branches of front part of mesh implant are passed by means of guides through obturator membrane along tendinous arch of pelvic fascia on skin of perineum, two branches from each side. Two branches of posterior part of mesh implant are passed through medial parts of sacrospinal ligaments on skin of perineum laterally and lower than anus by means of guides. Isthmus between anterior and posterior parts of mesh implant is fixed by its edges in its medium part to sacrouterine ligaments from two sides by nonabsorbable threads. Implant straightened in sagittal projection has form of "poker", and its short posterior part faces rectum. After straightening of front and back parts of implant and its isthmus fixation, free ends of branches of posterior part of implant are cut off subcutaneously, and branches of anterior part are sutured subcutaneously to each other without tension with non-absorbable sutures. Excess is cut off and submerged into tissues. Vaginal wall is sutured with uninterrupted absorbable sutures, skin cuts are sutured with interrupted sutures in the area of perineum.

EFFECT: method makes it possible to ensure creation of neo-fascia instead of destroyed one due to definite method of laying and fixing mesh implant as a result of selection of the strongest structures of small pelvis for its fixation, which prevents possible following protrusion of vagina walls in case of intra-abdominal pressure increase, as well as due to application of mesh implant made lighter due to definite structure.

2 dwg, 3 ex