COMBINED METHOD OF SURGICAL TREATMENT OF RECTOVAGINAL FISTULAS COMBINED WITH ANAL SPHINCTER DEFICIENCY BY RECTAL ANTERIOR WALL EVAPORATION WITH FISTULOUS OPENING, ANTERIOR SPHINCTEROLEVATOROPLASTY Russian patent published in 2020 - IPC A61B17/42 

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to colorectal surgery. Circular incision of a vaginal wall is made, enclosing a fistulous opening in the vagina, with formation of a wound through which access to levator muscles and an anal sphincter is possible. Cylindrical vaginal flap is mobilized. Fistulous passage, which is an extension of the vaginal flap, to the intestinal wall is separated without damaging its lumen. Isolated cylindrical flap and fistulous passage is invaginated into an intestinal lumen. Vaginal access is ensured by dividing the rectovaginal septum and mobilizing an anterior rectal wall with a blunt and acute approach in the proximal, distal and lateral directions. Anterior portions of levator muscles, an anal sphincter are recovered and mobilized, an invaginated cylindrical flap, a fistulous passage and an anterior rectal wall segment are evaginated, carrying a fistulous opening, through the anal canal outside of the lumen of the intestine, performing separate sutures of the front sphincterolevatoroplasty with seizure of the rectal wall lowered as a result of the evagination of the underlying segment in the line of sutures. Wound is closed in the vagina with separate sutures.

EFFECT: method enables avoiding the contact of the plastic surgery area with the intestinal lumen and/or the sutures line on the intestinal wall, fixing the rectal segment of the anterior rectal wall with the fistulous opening outside outside the intestinal lumen, and also allows not only correcting the anal sphincter deficiency, but also eliminating defects of rectovaginal septum of a large length, which significantly reduces the risk of recurrent disease and eliminates the phenomenon of anal incontinence.

1 cl, 1 ex