METHOD OF COMBINED SURGERY OF POSTHISTERECTOMY GENITAL HERNIA Russian patent published in 2015 - IPC A61B17/42 

FIELD: medicine.

SUBSTANCE: reinforcement of the vaginal walls with a mesh implant is carried out before or in the process of the said operation. After the stage of reinforcement of the vaginal walls with the mesh implant the following stages of operation are carried out: after transverse suprapubic laparotomy, transabdominally, the substage i, described below, and then - ii, are performed: i - the dome of the vagina is sewn from both sides with nonabsorbable ligatures, which are brought extraperitoneally by reverse movement by means of a guide probe on the anterior wall above the aponeurosis and fixed to the latter, with installing the vagina into the physiological position by pulling the ligatures; ii - obliteration of the Douglas space 3 with Mochkovich sutures is carried out. In case of necessity the substages i and ii are performed in a reverse order. The peritoneum is sewn with an uninterrupted suture, after which tissues of the retropubic space are separated in a blunt and sharp way downwards on internal surfaces of the pubic bones and the fascia of the internal obturator muscle leftward and rightward or in a reverse order with the realisation of the substage j and then substage jj described below: j - the urinary bladder is displaced rightward clearing the left side, with the application of a nonabsorbable suture, connecting a section of the left vaginal wall, projected by an assistant's finger, with the tendon arch of the pelvis fascia on the same side of the pelvic wall, application of the suture is performed at the level of the urinary bladder neck without tying the ligatures; jj - similar mirror-symmetric actions relative to the substage j are performed on the opposite side or, in case of necessity, the substages j and jj are performed in a reverse order. Before tying the ligatures medical glue for tissue gluing is applied more proximally and/or distally than the left and right suture on the line between the respective lateral pelvic wall and vaginal wall and/or on the surface of the interpubic articulation uniformly and/or locally. In case of palpatory and/or visual control the glued parts of the tissues are displaced and pressed upwards to the overlying tissues from the vagina side. Tying of the ligatures is performed with the provision of tissue gluing, after which the anterior abdominal wall is recovered layer-by-layer.

EFFECT: method makes it possible to increase the consistency and physiologicity of the apparatus for supporting internal genital organs formed in the process of the operation, provide reliable rehabilitation of patients with the prolapse of the genital organs.

3 cl, 2 ex