METHOD FOR TREATING COMBINED FORMS OF PELVIC PROLAPSE Russian patent published in 2023 - IPC A61B17/42 A61F2/02 

FIELD: medicine; operative gynecology.

SUBSTANCE: transvaginal surgical access to the pelvic organs, obturator membranes, sacrospinal ligaments and the middle part of the urethra is performed through a midline incision in the mucous membrane of the anterior vaginal wall with mobilization of the bladder and urethra in the middle third. Channels are formed to the upper and lower edges of the obturator membranes and sacrospinal ligaments on both sides. Then a suture is placed on the overstretched posterior wall of the bladder. Then titanium fixing elements with non-absorbable double ligatures are secured in the sacrospinal ligaments. A personalized implant is cut out of a titanium mesh fabric comprising a trapezoidal part, a ribbon-shaped part and a connecting section measuring 4-5 mm×4-5 mm, which connects the trapezoidal and ribbon-shaped parts of the implant. The dimensions of the smaller and larger bases of the trapezoidal part correspond to the upper and lower interobturator distances, respectively, and the height of the trapezoidal part corresponds to the longitudinal size of the prolapsed part of the anterior vaginal wall and the posterior wall of the bladder, the ribbon-shaped part has a length of at least 12 cm, a width of at least 0.8 cm. Next, the trapezoidal part of the implant is fixed in the obturator membranes using non-absorbable anchor threads, the ends of which are pre-fixed to the corners of the trapezoidal part of the implant, the free ends of the threads are sequentially passed transobturatorically and brought out to the skin through punctures in the area of the inguinal-femoral folds on both sides. Non-absorbable double ligatures from titanium fixing elements fixed in the sacrospinal ligaments from the side of the larger base of the trapezium are fixed to the trapezoidal part of the implant, retreating 1/3 of the distance from the lower left and right corner zones of the trapezoid, after which the ribbon-like part of the implant is brought under the middle zone of the urethra, the free ends of the tape-shaped part of the implant are pulled through the thickness of the soft tissues of the prepubic area and brought out onto the skin on both sides, after which the tape-shaped part of the implant is fixed to the paraurethral tissues with additional sutures. Then, by traction on the ends of the anchor non-absorbable threads brought to the skin and the free ends of the tape-shaped part of the implant, it is tensioned until the required position of the implant is achieved, followed by the removal of the skin parts of the anchor threads and the distal ends of the tape-shaped part of the implant.

EFFECT: method provides correction of combined forms of pelvic prolapse, such as prolapse of the anterior vaginal wall of II-III degree in combination with bladder descension, urethral hypermobility and stress urinary incontinence, while being highly effective and safe in the intra- and postoperative periods, helping to prevent possible complications and relapse of the disease.

9 cl, 2 ex, 3 dwg