METHOD OF TREATING POSTHYSTERECTOMY PROLAPSE USING VAGINAL ANTERIOR APPROACH USING POLYPROPYLENE IMPLANT WITH RESTORATION OF RECTOVAGINAL AND PUBOCERVICAL FASCIA Russian patent published in 2023 - IPC A61B17/42 A61F2/02 

FIELD: medicine; operative urology; gynecology.

SUBSTANCE: after preliminary hydrodissection, a longitudinal incision is made in the layer between the detrusor and the pubocervical fascia in the anterior wall and dome. Then the hernial sac is isolated without opening the abdominal cavity, and the edges of the pubocervical and rectovaginal fascia are isolated. The edge of the separation of the above fascia corresponds to the boundary of the disappearance of vaginal folding, the stumps of the cardinal and uterosacral ligaments are identified in their middle part and grabbed with clamps extraperitoneally and sutured with non-absorbable ligatures bilaterally. A lateral dissection of the vagina is performed until the tendinous arches of the pelvic fascia are exposed on both sides, the tendinous arch of the pelvic fascia is opened on the left using a sharp method, and the anterior surface of the sacrospinal ligament is exposed with the index finger. A puncture is formed according to the in-out principle using a transsacrospinal tunneler. Similar manipulations are performed on the opposite side; the ends of the polypropylene tape are passed through the middle sections of the sacrospinal ligaments. The rectovaginal fascia is fixed with a continuous non-absorbable suture with a thread to the mesh prosthesis, the stumps of the cardinal and uterosacral ligaments are sutured together. Fascia is fixed to the rectovaginal fascia and to polypropylene tape along the midline using non-absorbable ligatures. The edge of the pubocervical fascia is fixed to the cardinal and uterosacral ligaments in the center, to the polypropylene tape with separate non-absorbable sutures. The vaginal wound is sutured with a continuous Vicryl 2.0 suture, the tape is pulled under tension onto the skin of the buttocks, while the vaginal walls assume a normal anatomical position.

EFFECT: method allows to reduce the risk of damage to tissues and pelvic organs during surgery, since it does not require extensive intrapelvic dissection and allows not to use “large-scale”, “heavy” wide prostheses; it also reduces technical difficulties in eliminating anatomical defects of the pelvic floor, allows to achieve good functional results, restores the correct direction of the proximal part of the vagina, and helps to eliminate the risk of damage to the ureters and hypogastric nerve.

9 cl, 5 ex