METHOD FOR SURGICAL TREATMENT OF VAGINAL ENTEROCELE, RECTOCELE Russian patent published in 2016 - IPC A61B17/42 

FIELD: medicine.

SUBSTANCE: invention relates to medicine, specifically to surgical gynaecology. Following hysterectomy, method includes reinforcing front, middle part and vaginal vault and/or neck of uterus. Haemostasis is monitored, peritoneum is closed by a purse suture, wherein during operation for ligation, supporting, suspension and/or cross-linking tissues, non-absorbable suture material and mesh implant are used. Transvaginal and laparoscopic approach is used. Laparoscopy is carried out using two additional trocars, visually evaluating condition of pelvic organs and tissues, controlling process. Additionally at stage of laparoscopy and controlled by means of two conductors from place of occurrence of trocars right and left extraperitoneal formed channels to base of round uterine ligaments. Channels are formed further into vagina, conductors are left in channels,desuflation is carried out, trocars are removed. Then at stage of vaginal approach from posterior vaginal wall a triangular flap is cut out with its base downwards. Edge of vaginal mucosa is widely separated on both sides, in a blunt way to left and on right channels are formed to sacrospinal and/or sacrotuberal ligaments. Rectum is shifted to side and mobilised. From mesh implant flap is cut out of X-shape, size of middle platform which corresponds to area of coating of hernia defect enterocele and/or rectocele, middle part of implant is fixed to paravaginal tissues with non-absorbable ligatures with separate sutures. Lower two sleeves of implant are fixed to sacrospinal and/or sacrotuberal ligaments, each upper sleeve is elongated by ligatures. Further, ends of said ligatures by means of conductors, previously inserted into extraperitoneal channels, are delivered to anterior abdominal wall. Ligatures pulled until achieving correct physiological position of vaginal dome and adjacent organs and fastened on aponeurosis. Excess ligatures are removed, back wall and/or vaginal vault is restored. On levatory muscles supporting anus and on surface muscles, separate absorbable sutures are applied. Vaginal wall and skin are closed with separate absorbable sutures.

EFFECT: method enables to eliminate both primary and secondary enterocele and/or rectocele, reduces risk of tissue and pelvic injuries during surgical intervention.

5 cl, 2 ex