METHOD FOR SURGICAL TREATMENT OF ANTERIOR-APICAL PROLAPSE OF GENITALS Russian patent published in 2020 - IPC A61B17/42 

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to urogynecology. Implant is made from light polypropylene mesh in form of isosceles trapezoid with individual sizes for each patient, which are determined as follows: trapezoid height is equal to the distance from the introitus to the vaginal vault top, the wide trapezoid base being the front part of the implant is equal to half the distance between the inner surfaces of the ischial knots plus two centimeters, narrow trapezoid base, which is the rear part of the implant, is equal to the cervix width plus two centimeters. After that, to the sides of the mesh, 1–1.5 cm from the angles adjacent to the wide trapezoid base, the non-absorbable thread is fixed symmetrically to the left and to the right with two front polypropylene sleeves one centimeter wide and ten centimeters long. Anterior colpotomy is performed with compulsory dissection of the pubis-cervical fascia; a wide mobilization of the posterior wall of the bladder and its right and left lateral sides is performed; a paravaginal space and space around the foramen obturatum are exposed. In addition, from polypropylene mesh tape is made with width of one centimeter and length of twenty centimeters, to the middle part of which the narrow trapezoid base of the implant is fixed with separate interrupted sutures with non-absorbable prolenic suture with the possibility of formation of two back sleeves, with fixation of the middle of the back part of the implant to the cervix of the uterus or to the vaginal vault – in the absence of the uterus and its neck. Front sleeves are delivered through the foramen obturatum on the right and on the left; the rear sleeves of the implant are brought out into the abdominal cavity. Mesh polypropylene implant is placed under the pubis-cervical fascia, finally stretched and without tension is placed under the posterior wall of the urinary bladder. Vaginal mucosa is closed without excising an excess of vaginal mucosa, laparoscopic or laparotomy approach to the abdominal cavity. Back arms of the polypropylene implant are fixed to the Cooper ligament with the fixation device (hernia stapler) or by separate sutures with non-absorbable suture material; the cervix of the uterus and vagina in the form of a hammock is fixed. Peritonisation of the implant is ensured by a continuous suture with an absorbable suture material, sutures are applied on trocar wounds or a laparotomy wound is closed.

EFFECT: method enables reliably eliminating anterior-apical prolapse and reducing the number of intraoperative and postoperative complications, such as erosion, contraction of the prosthesis, pyoinflammatory complications.

1 cl, 2 dwg, 3 ex