RU2467699C1 - Method for fixation of reduced rectal segments in treating rectovaginal fistulas - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, specifically to surgery. A rectovaginal fistula is excised. A weaved point of front portions of levators and an intestinal wall is located. The front portions of levators are mobilised and partially transected in an attaching point to a pubic bone. The mobilised portions of levators are moved in the proximal direction. They are fixed in the direction opposite to an anal sphincter. It is followed by fixation of the transanal reduced segment to perianal skin.

EFFECT: method enables adequate fixation of the reduced rectal segment, eliminated suture tension on perianal skin, reduced risk of developing postoperative complications.

1 ex

Description

The invention relates to medicine, namely to colorectal surgery, and can be used to treat rectovaginal fistula.

The following methods are known for fixing the reduced segment of the wall of the rectum.

1. The reduced segment is fixed in its proximal part to the proximal part of the wound surface of the anal canal (to the skeletonized portion of the anal sphincter) and the first row of fixing sutures is formed. The second row of fixation sutures fixes the segment to the perianal skin.

Its disadvantages are:

- When using this method, the tension remains due to the fact that the front portions of the levator muscles are woven into the wall of the rectum into the anal sphincter. Their tension creates traction of the anterior wall of the rectum in the cranial direction.

The prototype of the proposed method for the treatment of rectocele is the fixation of a segment of the wall of the rectum in the treatment of extrasphincter fistula of the rectum.

The purpose of the invention:

- improve the results of surgical treatment of rectovaginal fistula by reducing the risk of postoperative complications.

Technique of the operation: after excision of the rectovaginal fistula by vaginal access (through the wound), the rectovaginal septum is cleaved, the posterior wall of the vagina is mobilized, and the front wall of the rectum is mobilized. Next, combined access is used to mobilize and form a segment of the wall of the rectum along the anterior semicircle. Then, when traction of the mobilized segment by tension, the places of weaving of the front portions of the levator muscles into the intestinal wall are determined. The front portions of the levator muscles are mobilized, which “pull” the intestinal wall in the cranial direction with their partial intersection at the place of attachment to the pubic bone. Then the mobilized muscles of the levators move proximal and are fixed in the transverse direction to the anal sphincter. A wound in the vagina is sutured. After this, the transanal reduced segment is fixed to the perianal skin.

Thus, the proposed method allows you to adequately fix the reduced segment of the intestinal wall along the front wall and eliminate the tension of the sutures on the perianal skin.

Clinical example:

Patient B., 51 years old, IS No. 1024-11, was admitted with complaints of gas and stool discharge through the vagina.

According to clinical and instrumental examination, the patient was diagnosed with a high level rectovaginal fistula.

03/10/2011, the patient underwent surgery by the proposed method. The postoperative period was uneventful. There was no pain. Postoperative wounds in the intestine and vagina healed by first intention. With stool, the patient did not note the above complaints. On day 8 was discharged.

The follow-up was 2 months. There is no data for relapse.

The proposed method in comparison with the known methods of surgical treatment of rectovaginal fistula makes it possible:

- reduce the risk of postoperative complications.

Bibliography:

1. Clinical operative coloproctology (edited by Fedorov VD, Vorobyev GI) M., 1994, p.363-367.

2. Coloproctology and the pelvic floor (edited by M.M. Henry, M. Swosh).

3. Surgical managenient of anorectal and colonic diseases. Marc-Claude Marti, Jean-Claude Givel. 1998.

4. The basics of coloproctology, edited by G. Vorobyov, M .: Medical Information Agency LLC, 2006, pp. 193-209.

Claims (1)

A method of fixing the reduced segment of the rectum in the treatment of rectovaginal fistula, based on the mobilization, reduction and fixation of the segment of the rectum, characterized in that it is determined by traction of the mobilized segment by tensioning the place for weaving the front portions of the levator muscles into the intestinal wall, mobilizing the front portions of the levator muscles, which stretch the intestinal wall in the cranial direction with their partial intersection at the site of attachment to the pubic bone, move the mobilized muscles of the levators proximal but also fix in the transverse direction to the anal sphincter, suture the wound in the vagina and fix the reduced segment to the perianal skin.