METHOD FOR THE TREATMENT OF ANTERIOR-APICAL PROLAPSE WITH GRADE 3-4 HYSTEROPTOSIS AND GRADE 2-3 CYSTOCELE USING A POLYPROPYLENE IMPLANT AND OWN TISSUES Russian patent published in 2022 - IPC A61B17/00 A61B17/42 A61F2/02 

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to urogynecology. After preliminary hydrodissection of the layer under the rectovaginal fascia, a longitudinal incision of 25-30 mm in length is made in the posterior wall of the vagina and the underlying fascia, starting from the posterior fornix. At the same time, pararectal canals are formed with the index finger to the ischial spines on both sides, exposing the anterior surface of the sacrospinal ligaments and displacing the rectum and pararectal tissue medially, using a transsacrospinal trocar, acting from the inside out, puncture the sacrospinal ligament in the region of its inner third in the middle of its width. 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, then a similar manipulation is performed on the opposite side. Next, an additional transverse incision of the mucous membrane of the anterior wall of the vagina of the fascia 25-30 mm wide is carried out, the isthmus of the uterus and the upper edge of the pubocervical fascia in the zone of its separation are mobilized, using a transobturator trocar of the type of Emet's needle used to install transobturator slings. A paracervical canal is formed from back to front, connecting the first and second incisions on the side to the right of the cervix, a similar tunnel is formed to the left of the cervix, provisional guidewires are inserted into the tunnels. The implant-tape is passed through the formed tunnels in such a way that the middle of the prosthesis covers 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 at 5 points with separate sutures is evenly sutured to the implant-tape with non-absorbable suture material 2- 0 in the area where the pubocervical fascia was previously woven into the elements of the isthmus of the uterus. Both vaginal incisions are sutured with 3-0 absorbable suture material; in the first row, the elements of the pubocervical fascia are additionally fixed to the cervix below the fixation of the implant-tape. At the end of the operation, the tightening of the sleeves of the implant-tape is accompanied by the expansion of the pubocervical fascia of the pelvis, raising and returning to their physiological anatomical positions of the uterus, bladder, anterior wall of the vagina and its dome.

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

2 cl, 2 ex