RU2197189C1 - Method for sacrovaginopexy after vaginal hysterectomy - Google Patents

Abstract

FIELD: medicine, operative gynecology. SUBSTANCE: sacrouterine ligaments and a rectovaginal septum are sutured from the side of a vagina. Then, under laparoscopic control one should direct a ligature by a blunt technique retroperitoneally up to a promontory. Promontory's periosteum is sutured. A ligature is withdrawn along a developed channel backwards into a vagina. Posterior vaginal wall is fixed to a promontory by connecting ligatures at the control for vaginal tension. EFFECT: decreased traumaticity level. 1 ex

Description

 The invention relates to medicine, in particular to operative gynecology.

 A known method of laparoscopic sacrovaginopexy after vaginal hysterectomy, in which the parietal leaf is opened along the sacral cavity to the right of the sigmoid and rectum, is fixed to the sacro-uterine ligaments with a merlene graft through an endoscope, a flap is pulled and sutured to the sacral cavity with a 4-5 ligature .V. Adamyan et al. "Corrective surgical interventions in combination of uterine fibroids with omission of genitalia" in the collection "Actual issues of obstetrics, gynecology and perinatology" Mo Squa-Surgut, 2001, pp. 294-303).

 The disadvantages of the method are the relatively high morbidity associated with the need for a wide opening of the parietal peritoneum (throughout the sacral cavity), a high risk of injury to adjacent organs, the risk of difficult to stop bleeding (when opening the parietal peritoneum), increased operation time due to the need for peritonization of the flap, lack of control beyond the degree of tension of the walls of the vagina.

 The objective of the invention is to reduce the morbidity, the risk of intra- and postoperative complications, shortening the time of surgery.

 The problem is solved by the method, namely, from the side of the vagina, the sacro-uterine ligaments and rectovaginal septum are sutured with non-absorbable suture material, then the thread is blunt under laparoscopic control, retroperitoneally to the promontorium, the periosteum of the promontorium is sutured and the thread is led back to the formed canal the vagina, which is connected with the second thread of the ligature and fixes the back wall of the vagina to the promotorium by binding the above threads when controlling vaginal tension.

 The following example illustrates the method of the invention.

 Patient G., 49 years old, was admitted to the Department of Endoscopic Surgery MONIIAG April 18, 2000 with complaints of drawing pains in the lower abdomen, dyspareunia, sensation of a foreign body in the vagina, constipation. With a diagnosis of incomplete uterine prolapse, prolapse of the walls of the vagina, rectocele, the patient was hospitalized and an operation was performed as planned on 19.04.2000: laparoscopic assisted vaginal hysterectomy without appendages, transvaginal retroperitoneal sacrovaginopexy under laparoscopic control. After a typical vaginal hysterectomy with laparoscopic assisting, the sacro-uterine ligaments and rectovaginal septum were sutured with non-absorbable suture material, then under the laparoscopic control, one thread was bluntly performed retroperitoneally to the promontorium, the periosteum was pierced and the duct was removed again associated with the second thread of the ligature and thereby fixed the back wall of the vagina to the promotorium by binding ysheukazannyh sheath filaments under the tension control.

 The inventive method was operated on 17 patients with prolapse of the uterus and prolapse of the walls of the vagina, entero-and rectocele. In none of the cases was observed intra- and postoperative complications.

 The age of patients ranged from 39 to 73 years, the average age of patients was 59 years. The duration of the disease according to the anamnesis was from 4 to 24 years.

 From the anamnesis, it was found that 53% of patients noted traumatic childbirth, 39% of patients indicate a connection between the disease and perimenopause.

 Examination of patients included general clinical tests, gynecological examination, ultrasound of the pelvic organs using vaginal and abdominal sensors, an urodynamic study.

 Based on the examination, the type of surgical aid was chosen. The choice was based on the severity of prolapse, the presence of pathology of the internal genital and adjacent organs, the age of patients, sexual activity, the presence of a history of operations on the pelvic organs, and concomitant pathology.

 The duration of hospital stay ranged from 3 to 5 days. The Folly catheter was removed on the 2nd day of the postoperative period. Long-term results were studied in the follow-up period of up to 3 years. Relapse of prolapse was not observed in any of the cases. There was a persistent clinical effect.

 The method we offer has the following advantages: due to retroperitoneal conduction of the thread, the invasiveness of the operation, the duration of the operation, the risk of injury to adjacent organs and vital vessels are reduced, and due to the combined access (laparoscopic and vaginal), the possibility of intraoperative control of the degree of vaginal tension is achieved. With this technique, the more physiological position of the vagina is preserved, which prevents sexual disorders after surgery.

Claims (1)

 The method of sacrovaginopexy after vaginal hysterectomy, including laparoscopic access and fixation of the sacro-uterine ligaments with the rectovaginal septum to the promontorium, characterized in that the sacro-uterine ligaments and rectovaginal sewing are stitched with a non-absorbable suture material from the vaginal side, then the laparoscopic method is performed using the laparoscopic method and then to the promontorium, the periosteum of the promontorium is stitched and the thread is withdrawn back along the formed channel the lineage, which is associated with the second thread of the ligature, and fix the back wall of the vagina to the promotorium by tying these threads to control the tension of the vagina.