METHOD FOR SURGICAL CORRECTION OF ANTERIOR VAGINAL WALL PROLAPSE IN FEMALE PATIENTS WITH CYSTOCELE FORMATION Russian patent published in 2025 - IPC A61B17/42 A61B17/12 

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to surgical urology and gynaecology. Vascular pedicle flap is cut out from the anterior wall of the vagina; the flap is mobilized together with the pubic-cervical fascia from the underlying tissues and the urinary bladder; the flap is sutured and fixed in the region of the internal obturator muscle with sutures passed through the obturator opening from both sides. At first, the anterior wall of the vagina is grasped with Allis clamps: one – in the proximal direction from the external urethral opening by 2 cm, the other one – at the cervix or vaginal dome. If the uterus is absent, the vaginal anterior wall and paravesical space are subjected to subfascial hydropreparation of 0.9 % sodium chloride solution in volume of 40 cm³. Then an incision is made on the anterior wall of the vagina to form a rectangular flap of excess tissue of the anterior vaginal wall on a vascular pedicle, with a base at the anterior lip of the cervix with length of 8 cm and width of 4-6 cm, at 2 cm from the external opening of the urethra to the vesicovaginal fatty tissue, unilateral apical sling is inserted through the right or left sacrospinal ligament; the paravaginal tissues are dissected by the lower branch of the pubic bone into the obturator opening and the internal obturator muscle. Incision is made on the skin within an inguinal-femoral fold in a projection of an upper medial part of the obturator opening, then a second incision is made 2 cm below and lateral to the right. Further, from the right upper angle along the lateral side of the formed flap, a continuous suture is applied to the middle of the distance of the base of the flap with a monofilament suture, the upper end of the suture is sutured to the pubic-cervical fascia at the upper edge of the wound in the region of the right arch, then this end of the suture is carried out from the inside out with the help of the UROFIX TO instrument by the lower branch of the pubic bone, the internal obturator muscle and the obturator membrane are perforated in the upper-medial part, the upper end of the suture is brought out in the upper part of the femoral-perineal fold. Lower end of the suture grabs the pubic-cervical fascia at the edge of the wound towards the lower branch of pubic bone 2-4 cm below the upper end of the suture, using the UROFIX TO instrument, the lower end of the suture is carried by the lower branch of the pubic bone from the inside out, by perforating the internal obturator muscle and the obturator membrane in medial part 2 cm below and lateral to the location of the previously applied upper end of the suture, it is brought out in femoral-perineal fold 2 cm below and lateral to the upper end of the suture on the right; a Kocher clamp is used to form a subcutaneous tunnel between the upper and lower end of the suture; the lower end of the suture is brought to the upper end of the suture in the subcutaneous tunnel. Then in a similar way, at the left upper corner along the lateral side of the formed flap, a continuous suture is applied to the middle of the distance of the base of the flap with a monofilament suture, pubic-cervical fascia is stitched with the upper end of the suture at the upper edge of the wound in the area of the left fornix, then the upper end of the suture is delivered from the inside out with the help of the UROFIX TO instrument by the lower branch of the pubic bone; the internal obturator muscle and the obturator membrane are perforated in the upper-medial part. Upper end of the suture is brought out in the upper part of the femoral-perineal fold; the lower end of the suture is used to catch the pubic-cervical fascia at the edge of the wound towards the lower branch of pubic bone 2-4 cm below the previously applied upper end of the suture on the left. Using the UROFIX TO instrument, the lower end of the suture is delivered by the lower branch of the pubic bone from inside to outside, perforating the internal obturator muscle and the obturator membrane in medial part 2 cm below and lateral to the upper suture on the left, brought out in femoral-perineal fold 2 cm below and lateral to the upper end of the suture, Kocher clamp is used to form a subcutaneous tunnel between the upper and lower end of the suture, the lower end of the suture is brought to the upper end of the suture in the subcutaneous tunnel. Upper edge of flap with polyfilament absorbable suture Vicryl USP 2/0 is fixed to pubic-cervical fascia paraurethrally on the right and on the left; flap is de-epitalised with a scalpel. Continuous suture is applied on the anterior wall of the vagina above the formed flap, closing the wound, the sutures brought out from the right and left are tightened and tied subcutaneously, reducing the prolapse of the anterior vaginal wall, traction is performed by an apical sling brought out in the right or left buttocks, reducing apical prolapse of the uterus.

EFFECT: method provides higher efficiency of surgical correction of prolapse of anterior vaginal wall in patients with formation of cystocele with simultaneous reduction of negative effects in postoperative period.

1 cl, 2 ex