METHOD FOR THE TREATMENT OF ANTERIOR-APICAL PROLAPSE OF 3-4 DEGREES USING A POLYPROPYLENE IMPLANT AND OWN TISSUES Russian patent published in 2022 - IPC A61B17/42 A61B17/00 A61F2/02 

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to urogynecology. After preliminary hydrodissection of the layer under the pubocervical fascia, a transverse incision of the mucous membrane of the anterior wall of the vagina is carried out. Mobilization of the intravaginal part of the hernia of the bladder is carried out together with the pubocervical fascia, the isthmus of the uterus and separately the upper edge of the pubocervical fascia in the area of ​​its anterior transverse defect. After the bladder hernia is displaced medially, the endopelvic fascia of the pelvis is opened medially using Cooper's scissors, as well as the mobilization and displacement of the intrapelvic part of the bladder and the ampullar rectum medially. The formation of paravesical and, in continuation, pararectal canals with ischial spines on both sides is carried out. The anterior surface of the sacrospinal ligaments is exposed, the rectum and pararectal tissue are additionally displaced medially, the sacrospinal ligament is punctured in the region of its inner third in the middle of its width using a transsacrospinal trocar according to the "inside-out" principle. Further along the trocar - sacrotuberous ligament, gluteal muscles, subcutaneous fat and skin of the gluteal region. During the puncture of the sacrospinal ligament, the index finger is placed between the trocar and the lateral wall of the rectum, insuring the latter from damage. A provisional thread-guide is passed through the puncture, the trocar is removed, a similar manipulation is performed on the opposite side, the implant-tape is passed through the formed tunnels. In this case, the middle of the prosthesis is fixed with a non-absorbable thread symmetrically along the line in three sections to the anterior semicircle of the isthmus of the uterus, and the sleeves of the tape are brought out transsacrospinally through punctures in the gluteal regions. The free edge of the mobilized pubocervical fascia with non-absorbable 2-0 suture material at 5 points with separate or continuous sutures is evenly sutured to the implant-tape and to the tissues of the isthmus of the uterus, completely covering the tape with elements of the pubocervical fascia. The vaginal incision is sutured with a two-row 3-0 absorbable suture material, the second row restores the mucous membrane of the anterior vaginal wall with a continuous suture. At the end of the operation, the final pull-up of the sleeves of the implant-tape is performed, when pulling up which the pubocervical fascia straightens, taking a normal anatomical position corresponding to the 0-stage of urogenital prolapse, in which the uterus, bladder, anterior wall of the vagina and its dome rise, returning to their physiological anatomical positions. The method includes synchronous correction of hysteroptosis by means of an implant-tape and cystocele by means of restoration of one's own tissues.

EFFECT: method allows to restore the anatomy of the pelvic floor, adequate urination and sexual life.

5 cl, 2 ex