METHOD OF TREATING HYSTEROPTOSIS AND RECTOCELE USING MESH POLYPROPYLENE IMPLANT AND PROPER TISSUES Russian patent published in 2024 - IPC A61B17/42 A61B17/34 A61F2/02 

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to urogynaecology. Longitudinal incision of a posterior vaginal wall and an underlying fascia is made, starting from a posterior fornix, with length of 25–30 mm. Index finger is used to form pararectal translevator canals to ischial spines on both sides. Anterior surface of the sacrospinal ligaments is cleaned by displacing the rectum and pararectal fat medially, using a transsacrospinal trocar on an inside-out principle, a sacrospinal ligament is punctured in the area of its internal one-third in the middle of its width, and further along the trocar – sacrobutoric ligament, gluteal muscles, subcutaneous fat and gluteal skin. During puncture of sacrospinal ligament with index finger located between trocar and lateral wall of rectum, the latter is insured against damage. Provisional guide suture is delivered through the puncture, a trocar is removed, a similar manipulation is performed from the opposite side. Then the middle part of the mesh prosthesis is fixed to the posterior surface of cervix for 2–4 cm with a continuous non-absorbable ethibond 1-0 suture. Further, the "sleeves" of the prosthesis are delivered through the sacrospinal ligaments by the in-out technique onto the skin of the gluteal region; the sacro-uterine ligaments are fixed to the posterior surface of the cervix and to the prosthesis in the form of a duplicate with non-absorbable ethibond 1-0 sutures. Free edge of the rectovaginal fascia is separated and fixed with a non-absorbable continuous prolene 2-0 suture to the posterior surface of the cervix, prosthesis is covered and the vaginal incision is closed with absorbable suture material 3-0. At the end of the operation, the implant tape sleeves are pulled up, the pull-up is accompanied by lifting and returning the uterus and the posterior wall of the vagina and its dome to their physiological positions. In a particular case, a CYRENE implant tape with the following characteristics is used: length – 20 cm, width – 4.5 cm, thread diameter – 0.15 mm, cell diameter – 0.50 mm, average weight – 70 g/cm², fraction of gaps in total area – 85%, breaking strength 55 N (Newton), extensibility, 57.3, material of manufacture – bioinert polypropylene.

EFFECT: method allows to reduce the risk of pelvic tissue and organs damage during surgical intervention, intraoperative complications, reduce technical difficulties in elimination of anatomical defects of pelvic floor, to achieve good functional results, return of uterus and posterior wall of vagina to initial anatomical points and to preserve uterus even in case of its prolapse.

2 cl, 2 ex