RU2277874C2 - Method for treating rectocele - Google Patents

Abstract

FIELD: medicine, operative gynecology.

SUBSTANCE: it is necessary to cut a fragment out of posterior vaginal wall being correspondent to its defect, cut a T-shaped prosthesis out of prolene netting, moreover, the size of prosthesis' vertical part corresponds to the size of the defect of peritoneal-perineal aponeurosis to cover the defect and fix to paravaginal tissues. Loose "arms" of prosthesis should be applied with the help of conductors from the upper part of the wound through middle third of levator's plateau and fiber of sciatic-rectal fossa towards the skin in projection of sciatic tubers. Then one should suture in vaginal mucous membrane above prostheses without tissue tightening. The innovation enables to strengthen peritoneal-perineal aponeurosis of vaginalposterior wall during the whole distance and prevent fragment's shift.

EFFECT: higher efficiency of therapy.

1 ex

Description

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

There is a method of colpoperineolevatoroplasty to eliminate prolapse of the posterior wall of the vagina, in which a triangular flap is cut out from the posterior wall of the vagina, muscles that raise the anus are secreted, which are subsequently sutured with 4-5 ligatures, followed by peritonization. The vaginal mucosa is restored with a continuous suture (Endoscopy in gynecology, edited by V.I. Kulakova, L.V. Adamyan, Moscow, “Medicine”, 2000, p. 307).

The disadvantages of the method is that it does not correct the defect of the posterior wall of the vagina throughout and does not allow to eliminate the defect of peritoneal-perineal aponeurosis.

The objective of the invention is a method of treating rectocele, allowing to correct defects in the posterior wall of the vagina and peritoneal-perineal aponeurosis.

The problem is solved by the method consisting in the fact that a flap corresponding to the size of a rectocele is cut out from the posterior wall of the vagina, and a T-shaped prosthesis is cut out from the prolene mesh. The dimensions of the vertical part should correspond to the size of the defect of the peritoneal-perineal aponeurosis. The prosthesis fits, covering the defect, and is fixed to the paravaginal tissues. The next step, using the IVS tuneler, is to conduct conductors from the upper wound site through the middle third of the levator plateau and the tissue of the sciatic-rectal fossa to the perineum on both sides. On the perineum, the passage points of the conductors are projected in the middle of the distance from the sciatic tubercles to the tendon center of the perineum. Using conductors, free horizontal shoulders of the prosthesis are held in both directions without fixation. The vaginal mucosa is sutured over the prosthesis without tissue tension.

The following example illustrates the method of the invention.

Patient E., 66 years old, was admitted to the Department of Endoscopic Surgery MONIIAG April 23, 2004 with complaints of drawing pains in the lower abdomen, the need for manual benefits for bowel movements, the periodic need for laxatives, constipation. With a diagnosis of failure of the pelvic floor muscles, rectocele. Made plastic back wall of the vagina according to the proposed method. A diamond-shaped flap of the mucosa of the posterior wall of the vagina in the lower third is excised. A flap of a T-shaped shape corresponding to a defect in the rectovaginal septum was cut from a prolene mesh. The prosthesis is laid covering the defect and fixed with non-absorbable ligatures to the paravaginal tissues. Then, the free ends of the prosthesis with the help of a conductor, are alternately drawn through the levators to the skin of the buttocks, in the region of the middle distance from the sciatic tubercles to the tendon center of the perineum. The vaginal mucosa is sutured with a continuous vikrilovy seam. Iodine. Blood loss 50 ml.

The postoperative period was uneventful, the patient was discharged on the 3rd day, in a satisfactory condition.

The inventive method was operated on 26 patients with varying degrees of prolapse of the posterior wall of the vagina. The age of patients ranged from 42 to 69 years. In 9 cases, patients before and after the operation underwent an X-ray examination of the rectum to determine its functional and anatomical state.

Results. In the follow-up period of up to 2 years, no relapse was noted. Intraoperatively, as well as in the postoperative period, there were no complications. The method is characterized by the simplicity of the operation, the absence of hemorrhagic and infectious complications, sexual discomfort, a decrease in the postoperative bed day. Improvement of the functional state of the rectum is determined not only clinically, but also with x-ray examination.

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, X-ray examination (proctodefectography).

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

The proposed method allows to strengthen the peritoneal-perineal aponeurosis of the posterior wall of the vagina throughout and to prevent displacement of the flap subsequently.

Claims (1)

A method for treating rectocele, including cutting a flap from the posterior wall of the vagina corresponding to its defect, and suturing the vaginal mucosa without tensioning the tissues, characterized in that a T-shaped prosthesis is cut out from the prolene mesh, the dimensions of the vertical part of which correspond to the dimensions of the peritoneal-perineal aponeurosis defect, close the defect with it and fix it to paravaginal tissues, free “shoulders” of the prosthesis are carried out using conductors from the upper wound site through the middle third of the levator plateau and cell attack of the sciatic-rectal fossa onto the skin in the projection of the sciatic tubercles, the mucous membrane of the vagina is sutured over the prostheses without tensioning the tissue.