METHOD FOR THE TREATMENT OF PATIENTS WITH TOTAL PELVIC FLOOR PROLAPSE Russian patent published in 2022 - IPC A61B17/42 

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to surgical gynecology and urology. After the installation of trocars leading the urinary bladder anteriorly and upward, and the uterus to the promontorium and upward, exposing the vesicouterine space at its bottom, the vesicouterine fold is incised along the anterior semicircle of the uterus. Allocate the anterior wall of the uterus and vagina, as well as the posterior wall of the bladder to the cervix. The body of the uterus is taken forward and upward, the bottom of the Douglas space is exposed, and the transitional fold is incised along the posterior semicircle of the cervix. Then the rectovaginal septum is disconnected until the levator and sphincter converge. The mesh graft is cut out in the shape shown in Fig. 1. The first longitudinal strip of the graft is placed in front of the uterus, fixed to the bladder, starting from the cervix, with 3-4 interrupted sutures, to the vagina, to the cervix and uterus with 5-6 interrupted sutures. Through the "windows" made in the wide ligament of the uterus, the second longitudinal strip of the graft is brought out onto the posterior wall and placed in the separated rectovaginal septum, fixed to the distal part of the levators, to the cervix and to the uterus, as well as to the second transverse strip of the graft. On the anterior abdominal wall in the area of ​​fixation of the round ligament of the uterus, the peritoneum is incised on both sides, the aponeurosis is exposed, to which the graft is sutured for the upper horizontal strip of the graft with 2-3 sutures, by forming nodes at the level of the aponeurosis through 2 mm incisions on the skin on both sides through all layers without tension. To the graft at the level of the cervix along the back wall, an additional cut out strip of mesh material is fixed with 2-3 sutures, which is also sutured to the presacral fascia on the right. The graft is covered with the peritoneum.

EFFECT: method allows performing plastic surgery of rectovaginal septum, vesicovaginal and vesicouterine spaces and resiliently fixing the pelvic organs in a natural position, thereby eliminating manifestations of pelvic prolapse, the possibility of recurrence and improving the quality of life of patients.

1 cl, 1 ex, 1 dwg