METHOD FOR SURGICAL CORRECTION OF COMBINED PELVIC ORGAN PROLAPSE Russian patent published in 2023 - IPC A61B17/42 A61F2/02 

FIELD: operative gynecology.

SUBSTANCE: laparoscopic fixation of two mesh tape-like endoprostheses to the anterior and posterior walls of the vagina is performed. The first endoprosthesis fixed to the anterior wall of the vagina, includes a longitudinal incision to the middle of the length to pass its individual ends through the avascular zone of the broad ligament of the uterus on both sides to the isthmus, then dissection of the pararectal tissue is performed bilaterally from the rectum until the walls of the vagina and the muscles that lift anus on both sides. The second tape-like mesh endoprosthesis is fixed to the muscles that lift the anus and the posterior vaginal wall with a separate interrupted suture using an absorbable bioinert thread, then the endoprosthesis tapes are fixed to the isthmus of the uterus with an interrupted suture with a non-absorbable bioenergetic thread. The excess tape of the endoprosthesis fixed to the anterior wall of the vagina is cut off, after which the cape of the sacrum is visualized, the peritoneum above it is opened below the aortic bifurcation, a longitudinal incision of the parietal peritoneum is performed towards the isthmus of the uterus, then the remaining endoprosthesis is fixed with an interrupted suture with a non-absorbable thread to the anterior longitudinal ligament of the spine above the cape of the sacrum, after which peritonization of the endoprosthesis is performed with sheets of peritoneum. Before fixing the mesh endoprosthesis, two rows of purse-string sutures are applied to the anterior wall of the vagina with an absorbable bioenergetic thread with the capture of the pubovaginal fascia and the muscular layer of the vagina, then the mesh endoprosthesis is fixed with two interrupted sutures using a non-absorbable thread, with the first suture being placed in a place located on 1–2 cm distal to the maximum prolapsing point, the second suture is placed 2–3 cm closer to the isthmus. Before fixing the mesh endoprosthesis to the posterior wall of the vagina, the bundles of muscles that lift the anus on both sides and the posterior wall of the vagina are sutured together with a separate interrupted suture above the anterior wall of the rectum.

EFFECT: method allows to reduce the risk of Mesh-associated complications, reduce the time of surgical intervention and reduce intraoperative blood loss, accelerate postoperative rehabilitation, restore the anatomy and function of the pelvic organs, including the restoration and/or maintenance of sexual function.

1 cl, 3 ex