METHOD FOR SURGICAL CORRECTION OF UTERINE SCAR DEFECTS AFTER CAESAREAN SECTION Russian patent published in 2023 - IPC A61B17/42 

FIELD: medicine; obstetrics; gynecology.

SUBSTANCE: excision of the thinned scar in the lower part is performed at an angle of 60 degrees to the longitudinal axis of the uterus from the cervical canal, in the upper part - at an angle of 120 degrees to the longitudinal axis of the uterus from the cervical canal. After that, layered closure of the uterus in two rows is performed. The first row is separate nodal extracorporeal muscular-muco-muscular sutures performed with Vicryl 2-0 thread at a distance of 5 mm from each other, the needle is inserted and punctured in the middle of the thickness of the myometrium pushed surfaces on both sides capturing the mucous layer. The second row is separate nodal extracorporeal musculo-musculoserous sutures with Vicryl 0 thread in a checkerboard pattern in relation to the sutures of the first row, the needle is inserted and punctured 4 mm from the incision edges on both sides and passed in the middle of the thickness of the myometrium pushed surfaces with subsequent peritonization of the suture line of peritoneum uterovesical fold using monocryl 2-0 thread. After that, plication and shortening of the round ligaments of uterus are performed by stitching the round ligaments of uterus along the whole length with “gathering” continuous sutures with a monofilament thread with a long resorption period “PDS * II 0”, starting from the place of their entry into the inguinal canal internal opening towards the uterus with the capture of the myometrium and vice versa, the needle is cut, skin incisions are made with 3 mm scalpel on both sides at points 1 cm above the projection of the inner ring of the inguinal canal. Free ends of the “PDS*II 0” threads are removed from the abdominal cavity with glover's needle, which is passed through these incisions twice through all layers of the anterior abdominal wall, leaving 3 mm aponeurotic bridge between injections, the ends of the threads are tied over the aponeurosis under visual control until the uterus reaches the position anteflexio.

EFFECT: method allows to increase the thickness of newly formed scar by increasing the area of pushed surfaces of the myometrium, helps to reduce tissue ischemia in the area of new scar due to layered restoration of the uterine wall and ensures wound healing without excessive tissue tension in the suture area due to plication and shortening of the round ligaments of the uterus and bringing it from the position of retroflexio to anteflexio.

1 cl, 2 ex