METHOD FOR AUGMENTATION ILEOCYSTOPLASTY USING A MARCIUS OR MARCIUS-SIMMONDS FLAP IN PATIENTS WITH RADIAL VESICOVAGINAL FISTULAS AND MICROCYSTIS Russian patent published in 2023 - IPC A61B17/00 A61B17/42 

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to operative urology. At the first - abdominal - stage, after reaching the exposure of the fistula, an incision is made in the bladder wall, bordering the fistula and in a sharp way, the walls of the bladder and vagina are separated for 1.5-2 cm. The anterior and lateral walls of the bladder are mobilized. The ureters are crossed at the level of the vagina. At the second - vaginal stage - one or two flaps of Marcius or Marcius-Simmonds are formed on the ventral or dorsal leg. After the creation of the paravaginal tunnel, the flap (or flaps) are moved into the pelvic cavity. At the third - abdominal - stage, the Marcius flap is fixed to the bladder and vagina, separating the suture lines of the vagina and bladder. If the Marcius-Simmonds flap is used, then the skin part of the flap along the entire circumference is sutured to the vaginal wall with separate interrupted sutures, and the muscle-fat part of the flap is fixed to the bladder and vagina. A segment of the ileum is formed, it is partially detubularized, leaving the cranial and caudal ends 3-4 cm long not detubularized, folded in a U-shape and sutured in the form of a duplication, lowered into the cavity of the small pelvis. Ileocystoanastomosis is performed with a continuous 2/0 absorbable suture. The distal ends of the ureters are spatulated and anastomosed with the non-detubularized ends of the ileum segment using the Wallece or Nesbit technique on external ureteral stents.

EFFECT: method allows to completely restore voluntary urination in patients with large radial vesicovaginal fistulas in combination with microcystis.

3 cl, 1 ex