METHOD OF METROPLASTY WITH THINNING OF UTERINE SCAR AFTER CAESAREAN SECTION WITH REPEATED CAESAREAN SECTION Russian patent published in 2024 - IPC A61B17/42 A61B17/04 

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to obstetrics and gynaecology. Laparotomy is performed with excision of a skin cicatrix, a visceral peritoneum is opened within a lower segment of the uterus. Transverse incision of myometrium 1.5-2 cm long is performed along the upper edge of the visually changed wall of the lower uterine segment. Incision is expanded to 10-12 cm by an acute method, the foetus is removed and the placenta is removed, the bladder is dissected to the lower edge of the uterine cervix with exposing the anterior and lateral surfaces of the isthmus and uterine cervix, and the area of uterine vascular bundles. Thinning area of the uterine scar is excised so that the thickness of the lower edge of the wound is not less than 60% of the thickness of the upper edge of the wound. Hysterotomic incision is closed with a continuous two-row suture, the first row of the suture, muscular-mucous, is performed with the endometrium capture. First prick in is made in the middle of the thickness of the upper edge of the wound, and the prick out is made 5 mm from the edge, then the prick in is made on the lower edge of the wound, while retreating 5 mm from the edge, and the prick out is made in the middle of the thickness of the edge. Second row of the suture, musculo-muscular, is performed in the opposite direction, the first prick in is made at distance of 5 mm from the lower edge of the wound, and the prick out is made in the middle of the thickness of the lower edge, then the prick in is made in the middle of the thickness of the upper edge and the prick out is made at distance of 5 mm from the upper edge.

EFFECT: method enables improving visualization of the thinning area of the uterine scar for its adequate excision, as well as reducing the probability of uterine vascular bundles injury due to wide dissection of the bladder; minimizing the frequency of uterine shape disorders and formation of a scar defect on the uterus by suturing the upper and lower edges of the uterine incision comparable in thickness; reduce injuries of repeated Caesarean section due to absence of peritonisation of suture on uterus by visceral peritoneum.

1 cl, 5 ex