RU2661042C1 - Method for surgical reconstruction of the pelvic floor - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to surgery and may be applicable to the reconstruction of the pelvic floor. Purpose is a knitted endoprosthesis-ribbon with an atraumatic margin 15 mm wide macroporous structure, UroSling-1, Lintex is installed through the front access when the front compartment of the pelvic floor is lowered or rear access is provided when the rear compartment is lowered. Endoprosthesis tape is fixed with three sutures to the cervix using a non-absorbable bioinertal thread, leaving the ends of the filaments of one of the seams. Colporaphy is performed in a compartment corresponding to the access made by applying a subfascial continuous seam using a non-absorbable bioinert thread, with subsequent binding of left ends of filaments of one of the three joints that fixed the endoprosthesis-tape to the cervix with the filament of the colportrial suture.

EFFECT: method allows to increase reliability of fixing the endoprosthesis, to provide the possibility of monitoring the depth of the joint.

1 cl, 1 dwg, 1 tbl, 2 ex

Description

The invention relates to medicine, namely to urology, gynecology and proctology and can be used for surgical reconstruction of the pelvic floor in order to restore the normal functioning of internal organs such as the bladder and rectum, as well as for the prevention of relapse of the disease and improve the quality of life of patients.

Surgical reconstruction of the pelvic floor is used for pathological prolapse of the internal female genital organs, prolapse and dysfunction of the bladder and rectum. Pelvic organ prolapse (VET) is found in 15-30% of the female population. In postmenopausal women with estrogen deficiency, the incidence of PTV reaches 50-78% and is combined with urinary incontinence in 70.1%, defecation disorders in 36.5% and dyspareunia in 53.3% of patients. VET - pathologies that dramatically reduce the quality of life, sometimes even more than diseases such as coronary heart disease and diabetes mellitus, often lead to complete social maladaptation of patients [1].

Operations for lowering the pelvic organs can be divided into interventions performed through the abdominal cavity and operations performed by vaginal access. Among transvaginal operations, it is conditionally possible to distinguish plastics with their own tissues, own tissues using hard fixation points and plastic using endoprostheses; combined operations are also used.

A known method of reconstruction of the endopelvic and rectovaginal fascia [2]. The technique consists in plicating the fascia by suturing its outer surface

The disadvantages of this method are:

- The inability to control the depth of the suture, therefore, with its superficial application, the risk of ligature eruption is high, which increases the risk of relapse (according to various sources, 22-55%) [3-6].

- The use of absorbable ligatures does not allow a reliable scar to form in the area of operation.

- In the case of deeper stitching, the risk of bladder flashing increases [5].

A known system and method of implant placement [7]. The system includes a mesh implant and a device for its installation. The tool is a set consisting of a conductor with a perforating tissue tip, a cannula and an extraction device with a gripping element at its distal end. The channel inside the cannula allows the conductor and the extraction device to advance through it, with the possibility of expansion when the implant is advanced.

The disadvantages of such a system are:

- The use of a full-sized mesh implant increases the risk of complications: mucosal erosion (3.6%), bladder perforations (1-4.3%), urinary incontinence (due to decreased mobility of the bladder neck (6.9-13%) dyspareunia (15%) [8-9].

- when a hollow plastic cannula is inserted through the sacro-spinal ligaments due to an acute bending angle and insufficient rigidity, its inner channel can be deformed, which makes it difficult to conduct a mesh implant;

- due to the insufficient length of the cannula, its passage through the sacrospinal ligaments is very difficult in patients with a high body mass index.

A known method of reconstruction of the apical pelvic floor. The technique consists in fixing the paracervical ring with non-absorbable ligatures to the sacrospinal ligaments using a special stitching device [10].

The disadvantages of the method:

- support only of the apical department increases the risk of relapse in an unoperated compartment;

- the use of special flashing devices requires wide dissection in the area of the sacrospinal ligaments, which increases the risk of complications (damage to large vessels and the rectum) [11-14].

There is a method of reconstruction of the vesicovaginal septum during surgical treatment of prolapse and prolapse of the anterior vaginal wall and cystocele [15].

The method includes suturing the urethrovesical segment and the bottom of the bladder, suturing the vesicovaginal fascia and the anterior wall of the vagina. An overstretched posterior wall and the bottom of the bladder are sutured with a purse string suture with simultaneous strengthening with a synthetic endoprosthesis.

Disadvantages:

- sutures are applied to the outer surface of the pubic-cervical fascia and the posterior wall of the bladder, which does not allow controlling the depth of suturing. When superficially applied, the risk of ligature eruption is high, which increases the risk of relapse. In case of deeper stitching, the risk of flashing the wall of the bladder increases.

- The use of a purse string suture reduces the length of the front wall of the vagina, which can lead to a change in the shape of the vagina, its mobility, the occurrence of pain symptoms and impaired urinary retention.

- The use of a large mesh implant and its submucosal location increases the risk of developing implant-associated complications (erosion, dyspareunia, etc.).

- The absence of apical fixation of the endoprosthesis significantly increases the risk of prolapse recurrence.

As a prototype for the closest technical essence, we have chosen a method for surgical reconstruction of the apical pelvic floor compartment using 8 mm polypropylene multifilament endoprosthesis tape [16].

The method consists in making a vertical incision of the posterior wall of the vagina directly under the neck or arch with dissection of the rectovaginal space to release the recto and enterocele from the adjacent tissues. The sciatic spine is defined on each side as a guide point for the IVS conductor tunnel. Two half-centimeter skin incisions are made in the perianal region under the sciatic tubercles at 4 and 8 hours in the middle of the distance between the coccyx and the external sphincter of the anus, 3 cm lateral from the last. The tunnel conductor is conducted through the incision and the plane of the levators into the sciatic-rectal fossa to the level of the sciatic awns. At this point, the tunnel conductor is rotated medially and brought out through a vertical section of the vagina, focusing on the sciatic spine when choosing the plane of passage through the rectovaginal fascia. A microporous polyfilament endoprosthesis tape 8 mm wide is passed through the conductor. The procedure is performed on the opposite side. An 8 mm wide endoprosthesis tape is fixed to the vaginal stump or cervix with two single sutures with an absorbable PDS 2/0 suture. A vertical 1/4 vicryl suture is applied to the vertical section of the vagina. If there is a prolapse of the anterior vaginal wall, anterior colporography (plastic surgery of the anterior compartment of the pelvic floor) is performed.

The disadvantages of the method selected as a prototype are:

- using as an access only the posterior wall of the vagina, regardless of the compartment in which the prolapse predominates, that is, the anterior or posterior wall of the vagina;

- lack of reconstruction of the endopelvic fascia, combined with the restoration of the apical compartment, which increases the risk of recurrence of prolapse in the access area;

- the installation of the endoprosthesis only in the muscle-fascial tissues without passing through the solid, fixed structures of the pelvic floor increases the risk of implant displacement, and as a result, the prolapse recurrence in the apical part;

- the use of an endoprosthesis-tape of insufficient width does not allow it to be firmly fixed in the tissues, which can lead to a displacement of the mesh endoprosthesis and the development of relapse prolapse;

- fixation of the endoprosthesis with two sutures from an absorbable suture does not allow the formation of a reliable scar in the area of the endoprosthesis and increases the risk of it detaching from the attachment point, which leads to a relapse of prolapse in the apical region;

- performing anterior colporography using a traditional technique with suturing on the anterior surface of the endopelvic fascia does not allow controlling its depth, which, if it is superficially performed, can lead to relapse of prolapse in the anterior section, and if deeper, increases the risk of perforation of the bladder;

- the use of a one-component metal conductor tunnel, due to its rigidity and a sharp tip, increases the risk of damage to the internal structures of the pelvis (rectum, bladder, large vessels);

- the passage of the tunnel through the skin incisions of the perianal region 3 cm lateral from the anus does not sufficiently prevent the risk of damage to the rectum;

- the use of an endoprosthesis-tape with a microporous multifilament structure increases the risk of infectious complications in the postoperative period;

- isolation of the mesh endoprosthesis from the vaginal cavity only with a suture applied to the mucosa can lead to extrusion of the implant in case of failure of the latter.

The objective of the invention is to increase the efficiency of the method of surgical reconstruction of the pelvic floor, which consists in:

- to increase the reliability of the operation by reducing the risk of relapse both in the apical compartment of the pelvic floor and in the access area, that is, in the area of the posterior wall of the vagina;

- in the prevention of recurrence of prolapse when lowering the anterior compartment of the pelvic floor;

- in reducing the number of repeated surgical interventions;

- to reduce the risk of such postoperative implant-associated complications as suppuration of the endoprosthesis in the tissues, as well as erosion of the vaginal mucosa;

- to increase the safety of surgery by reducing the risk of damage to the internal structures of the pelvis (rectum, bladder, large vessels);

The technical result achieved using the invention:

- elimination of a defect in the endopelvic fascia (pubic-cervical with anterior access, recto-vaginal with posterior) in combination with restoration of the apical compartment;

- improving the reliability of fixation of the endoprosthesis by reducing the risk of its displacement;

- the ability to control the depth of the seam during the reconstruction of the recto-vaginal or pubic-cervical fascia;

- the choice of mesh endoprosthesis-tape with technical characteristics that reduce the risk of such postoperative implant-associated complications as suppuration of the endoprosthesis in tissues;

- the choice of a system for installing a mesh endoprosthesis-tape, as well as the required distance of the tunnel relative to the external sphincter of the rectum, which reduces the risk of damage to the internal structures of the pelvis (rectum, bladder, large vessels);

- the ability to isolate the mesh endoprosthesis-tape from the vaginal mucosa in order to reduce the risk of erosion.

The technical result is achieved by the fact that the method of surgical reconstruction of the pelvic floor consists in the vaginal installation of a polypropylene seamless knitted mesh endoprosthesis with an atraumatic edge 15 mm wide of the macroporous structure UroSling-1, Linteks through front access when lowering the anterior compartment of the pelvic floor or posterior access when lowering the posterior compartment . The specified endoprosthesis tape is passed through a tunnel, which is a symmetrical single-row metal spiral, which is wound round to round, with a diameter 1 mm larger than the diameter of the conductor, and coated on the outside with a polypropylene sheath. The tunnel is carried out through incisions made on the skin of the perianal region under the sciatic tubercles for 4 and 8 hours in the middle of the distance between the coccyx and the external sphincter of the anus, 5 cm lateral from the latter into the sciatic-rectal space with passage through the sacral-spinous ligaments. inside "using a curved metal conductor, made in the form of a pin with the withdrawal in the area of access made. The distal ends of the aforementioned endoprosthesis tape are bilaterally removed to skin incisions previously performed in the perianal region. Then, the aforementioned endoprosthesis tape is fixed with three sutures to the cervix using a non-absorbable bioinert thread, leaving the ends of the threads of one of the sutures. Then they perform colporography in the compartment corresponding to the access made by applying a subfascial continuous suture using a non-absorbable bioinert filament. Subsequently, the left ends of the threads of one of the three sutures that fixed the endoprosthesis to the cervix are connected with the suture of the colporrhagic suture. When applying a subfascial continuous suture with a thinned vaginal wall, an absorbable thread is used.

The method is as follows:

The patient is placed in a position for lithotomy, injected into anesthesia, a Foley 18 or 20 Ch urethral catheter is placed, and it is connected to the urinal. Hydropreparation is performed with a 0.9% physiological solution of sodium chloride of the anterior (or posterior) vaginal wall. The installation of a synthetic integrally knitted endoprosthesis-tape with an atraumatic edge with a width of 15 mm of the macroporous structure UroSling-1, Linteks is performed through the front access in case of lowering the anterior compartment of the pelvic floor or through the rear access in case of omission of the anterior compartment. The vaginal mucosa is gripped by Allis clamps. Subvascial dissection of paravaginal tissues is performed bluntly in the direction of the sacrospinal ligaments on each side. The scalpel makes incisions on the skin of the perianal region under the sciatic tubercles at 4 and 8 hours in the middle of the distance between the coccyx and the external sphincter of the anus, 5 cm lateral from the latter. Through cuts from the outside, a curved metal conductor is introduced, made in the form of a pin with a tunnel mounted on it, which is a symmetrical single-row metal spiral that is wound round to round, with a diameter 1 mm larger than the diameter of the conductor and coated on the outside with a polypropylene sheath.

The conductor is introduced in the direction of the sacrospinal ligaments. After perforation of the latter, the distal end of the tunnel is captured with fingers, pulled from the conductor and removed through the vagina in the access area. Through the tunnel from the inside out, the aforementioned endoprosthesis tape is carried out, then a symmetrical action is performed on the other hand. After carrying out the aforementioned endoprosthesis, the tape is straightened and fixed to the cervix with 3 sutures using a non-absorbable bioinert thread, leaving the ends of the threads of one of the sutures. After fixation of the endoprosthesis, the tape is performed colporography in the compartment corresponding to the produced access by applying a subfascial continuous suture using a non-absorbable bioinert thread. With a thinned vaginal wall, an absorbable thread is used. The anterior colporography is performed with a central or paracervical defect of the pubic-cervical fascia, and the posterior one with a defect of recto-vaginal fascia. After completion of the subfascial continuous suture, the suture thread is tied to the left ends of the threads of one of the three sutures that have fixed the endoprosthesis, which leads to fixation of the colporrafic suture to the endoprosthesis, which is shown in FIG. 1, where 1 is a synthetic seamless knitted endoprosthesis tape, 2 is a kolporrafic seam, 3 is the left ends of the threads of one of the three seams that fixed the endoprosthesis.

Hemostasis. Suture on the wound of the vagina with absorbable suture material. Then, the endoprosthesis is pulled by its distal ends, due to which the anatomical position of the vaginal departments is restored. Control of the lumen of the rectum - if necessary, adjust the tension of the endoprosthesis. The distal ends of the implant are cut off.

As a non-absorbable thread, we used the bioinert thread Fluorex. It is possible to use other non-absorbable threads, such as, for example, Etibond, Sintofil, Polyester.

As the absorbable thread, we used the PHA thread, but it is possible to use other absorbable threads, such as, for example, Ultrasorb or Vikril.

The essential distinguishing features of the invention and the causal relationship between them and the achieved result:

- Use a seamless knitted endoprosthesis tape with an atraumatic edge with a width of 15 mm of a macroporous structure, UroSling-1, Linteks. Mesh endoprosthesis tape UroSling-1, Linteks is used for surgical treatment of apical prolapse. The knitting feature of this endoprosthesis-tape prevents excessive stretching of the endoprosthesis, and also increases its strength. The macroporous structure reduces the risk of developing infectious complications, namely suppuration of the endoprosthesis in the tissues.

The use of such an endoprosthesis provides reliable fixation in tissues, reduces the risk of its displacement, and, consequently, relapse of pelvic organ prolapse. The atraumatic edge of the specified endoprosthesis-tape allows you to safely adjust the tension of the endoprosthesis in the first hours after surgery [17] http://nelaton.ru/surgery/setki-uroginekologiia/urosling-1-linteks].

- The tunnel is carried out in the sciatic-rectal space through the sacral-spinous ligaments "outside-in", and since subsequently an endoprosthesis tape is passed through the tunnel, then after removal of the tunnel the endoprosthesis tape remains fixed in the sacro-spinous ligaments, which are strong, inextensible structures pelvic floor. Thus, the location of the endoprosthesis-tape in the sacro-spinal ligaments contributes to greater resistance of the latter, resulting in a reduced risk of displacement, and, consequently, relapse in the apical compartment.

The selected set of tools involves a tunnel using the method of "outside-in."

- Install the endoprosthesis tape through the front access when lowering the anterior compartment of the pelvic floor or the rear access when lowering the posterior compartment, that is, the endoprosthesis is installed depending on the prevailing defect.

The possibility of installation through anterior or posterior approaches allows eliminating a defect of the pubic-cervical fascia with anterior or recto-vaginal fascia with posterior access, producing subfascial colporography, in combination with restoration of the apical compartment, achieved by fixing the cervix to the endoprosthesis, which is used to replace the sacro-prosthetic uterine ligaments.

- Use a tool kit consisting of a tunnel, which is a symmetrical single-row metal spiral, which is wound round to round, with a diameter 1 mm larger than the diameter of the conductor and coated on the outside with a polypropylene sheath, and a curved metal conductor made in the form of a pin.

The combination of these tools ensures their safe use in tissues, which is achieved by the fact that the conductor only forms a hole in the dense structures of the pelvis, pushing the tissues apart, and the tunnel, after opening the fixing handle of the conductor, is easily removed and advanced in the formed channel without bending or deforming due to in the form of a spiral. And its resistance to deformations of the internal lumen allows the free passage of the endoprosthesis-tape through it. All this prevents damage to the rectum, bladder, large vessels.

A symmetric single-row steel spiral has a diameter 1 mm larger than the diameter of the conductor so that the conductor can be put on the specified spiral.

The symmetric single-row steel spiral is coated on the outside with a polypropylene sheath, which allows the tunnel to be carried out unhindered in both soft and dense connective tissue structures.

The execution of a spiral made of metal ensures its elasticity, resistance to stretching and bending, which allows a tunnel to be freely carried in dense connective tissue structures of the pelvis, and then through its lumen and endoprosthesis.

- The tunnel is carried out in the sciatic-rectal space 5 cm lateral from the external sphincter of the anus, which minimizes the risk of damage to the rectum.

- Then, the aforementioned endoprosthesis tape is fixed with 3 sutures to the cervix using a non-absorbable bioinert thread.

Fixation of the endoprosthesis-tape with 3 sutures to the cervix, as well as the use of non-absorbable bioinert thread increases the reliability of fixation of the endoprosthesis-tape, which, in turn, reduces the risk of recurrence of prolapse, in contrast to the prototype method, in which an absorbable thread is used for this purpose.

- Leaving the ends of the threads of one of the 3 sutures that fixed the endoprosthesis, followed by their binding to the suture of the colporrhagic suture.

The binding of the suture of the colporrafic suture with the sutures that fix the endoprosthesis tape provides additional support for the endopelvic fascia, and also contributes to the spread of the scarring process that accompanies the integration of the prosthesis into the tissue to the area reconstructed using the kolporrafic suture of the fascia. As a result, a “single structure” is created that strengthens the pubic-cervical or recto-vaginal fascia, which helps to reduce relapse in the corresponding compartment.

- After fixing the aforementioned endoprosthesis, the tape is performed colposography in the compartment corresponding to the access made by applying a subfascial continuous suture using a non-absorbable bioinert thread, and with a thinned vaginal wall, an absorbable thread is used.

Performing anterior colporography in the anterior compartment allows the central or paracervical defect of the pubic-cervical fascia to be eliminated, and performing posterior colporography — a recto-vaginal fascia defect.

Performing a subfascial continuous seam allows you to:

- tightly and reliably close the defect of the damaged fascia;

- to provide the possibility of visual control, which, in turn, eliminates damage to the bladder, rectum and vaginal walls, and also reduces the risk of recurrence of prolapse;

- to provide the ability to isolate the mesh endoprosthesis-tape from the vaginal mucosa in order to reduce the risk of erosion.

The use of non-absorbable sutures when applying a subfascial continuous suture also ensures the reliability of colporography, which reduces the risk of prolapse recurrence.

The use of absorbable sutures with a thinned vaginal wall, on the one hand, allows for a reliable suture to capture the maximum volume of tissue, and on the other hand, in the case of a submucosal arrangement of the thread, it eliminates the risk of subsequent extrusion of the thread into the vagina, and also reduces the risk of prolapse recurrence.

The set of distinctive essential features is new and allows you to:

- to eliminate the defect of the endopelvic fascia (pubic-cervical with anterior access, recto-vaginal - with posterior) in combination with restoration of the apical compartment;

- to increase the reliability of fixation of the endoprosthesis by reducing the risk of its displacement;

- control the depth of the seam when performing reconstruction of the recto-vaginal or pubic-cervical fascia;

- reduce the risk of such a postoperative implant-associated complication as suppuration of the endoprosthesis in the tissues, as well as the risk of damage to the internal structures of the pelvis (rectum, bladder, large vessels);

- choose a mesh endoprosthesis with technical characteristics that reduce the risk of such a postoperative implant-associated complication as suppuration of the endoprosthesis in tissues;

- choose a system for installing a mesh endoprosthesis-tape, as well as the required distance of the tunnel relative to the external sphincter of the rectum, which reduces the risk of damage to the internal structures of the pelvis (rectum, bladder, large vessels);

- isolate the mesh endoprosthesis from the vaginal mucosa in order to reduce the risk of erosion,

which, in turn, increases the efficiency of the method of surgical reconstruction of the pelvic floor due to

- increase the reliability of the operation by reducing the risk of relapse both in the apical compartment of the pelvic floor and in the access area, that is, in the area of the posterior wall of the vagina;

- prophylaxis of relapse prolapse when lowering the anterior compartment of the pelvic floor;

- reduce the number of repeated surgical interventions;

- reducing the risk of such postoperative implant-associated complications as suppuration of the endoprosthesis in the tissues, as well as erosion of the vaginal mucosa;

- increase the safety of surgery by reducing the risk of damage to the internal structures of the pelvis (rectum, bladder, large vessels).

We give examples from clinical practice:

Example 1

Patient M., 63 years old.

Received on a planned basis 04/20/2015 at the "St. Petersburg Multidisciplinary Center" of the Ministry of Health of Russia with a diagnosis of Prolapse of the pelvic organs. Cystocele 3 tbsp. Apical prolapse "for surgical treatment. Objectively: when viewed on a chair during straining, the protrusion of the front wall of the vagina and uterus is determined by 2/3 beyond the genital gap, which according to the Baden-Walker classification corresponds to 3 stages of pelvic prolapse. 04/21/2015, taking into account the paracervical defect of the pubic-cervical fascia in combination with apical prolapse, the Urosling-1 endoprosthesis was implanted, Lintex in combination with the anterior subfascial colporrafia of a non-absorbable bioinerous thread Fluorex with subsequent binding of the left ends of the threads of one of the three endoprostheses fix to the cervix with a thread of colporrafic suture. This made it possible to eliminate apical prolapse, paracervical defect of the pubic-cervical fascia, minimize the risk of intraoperative complications in the form of perforation of the bladder and long-term complications in the form of suppuration of the endoprosthesis, and significantly reduce the risk of recurrence of prolapse in the anterior and apical compartments of the pelvic floor. The postoperative period was uneventful. There are no complaints. Normal urination, sufficient urine retention, no pain. Primary healing. Skin sutures were removed on the 3rd day after surgery. Discharged under the supervision of a gynecologist's antenatal clinic. Examined after 1, 3, 6, 12 and 24 months after surgery. No complaints. Erosion of the vaginal mucosa was not detected. There is no recurrence of pelvic organ prolapse, no repeated surgery. Notes a significant improvement in the quality of life.

Example 2

Patient O., 70 years old.

Received on a planned basis 05.04.2015 at the "St. Petersburg Multidisciplinary Center" of the Ministry of Health of Russia with a diagnosis of Prolapse of the pelvic organs. Apical prolapse. Rectocele 3 tbsp. "For surgical treatment. Objectively: when viewed on a chair during straining, the protrusion of the posterior wall of the vagina and uterus by 2/3 beyond the genital gap is determined, which, according to the Baden-Walker classification, corresponds to 3 stages of pelvic prolapse. 04/06/2015, taking into account the defect of recto-vaginal fascia in combination with apical prolapse, implantation of the Urosling-1 endoprosthesis was performed, Lintex in combination with posterior subfascial colporrafia with non-absorbable bioinerous thread Fluorex followed by binding of the left ends of the threads of one of the three sutures that fixed the endoprosthesis the cervix with a thread of colporrafic suture. This allowed us to simultaneously eliminate apical prolapse and recto-vaginal fascia defect, minimize the risk of intraoperative complications in the form of rectal perforation and long-term complications in the form of suppuration of the endoprosthesis, and significantly reduce the risk of prolapse recurrence in the posterior and apical pelvic floor compartments. The postoperative period was uneventful. There are no complaints. Normal urination, sufficient urine retention, no pain. There is no violation of bowel movements. Primary healing. Skin sutures were removed on the 3rd day after surgery. Discharged under the supervision of a gynecologist's antenatal clinic. Examined after 1, 3, 6, 12 and 24 months after surgery. No complaints. There is no recurrence of pelvic organ prolapse, no repeated surgery. Erosion of the vaginal mucosa was not detected. Notes a significant improvement in the quality of life. The data obtained during the testing of the proposed method were compared with the data described in the prototype method. The data obtained are presented in table 1.

Comparative data shown in table 1, convincingly prove an increase in the effectiveness of the proposed method, compared with the prototype.

The inventive method was successfully tested in the urological and gynecological departments of the St. Petersburg Multidisciplinary Center of the Ministry of Health of the Russian Federation in 186 patients.

Thus, the claimed method of reconstruction of the pelvic floor allows you to:

- to eliminate the defect of the endopelvic fascia (pubic-cervical with anterior access, recto-vaginal - with posterior) in combination with restoration of the apical compartment;

- to increase the reliability of fixation of the endoprosthesis by reducing the risk of its displacement;

- control the depth of the seam when performing reconstruction of the recto-vaginal or pubic-cervical fascia;

- reduce the risk of such a postoperative implant-associated complication as suppuration of the endoprosthesis in the tissues, as well as the risk of damage to the internal structures of the pelvis (rectum, bladder, large vessels);

- isolate the mesh endoprosthesis from the vaginal mucosa in order to reduce the risk of erosion,

which, in turn, increases the effectiveness of the method of surgical reconstruction of the pelvic floor due to:

- to increase the reliability of the operation by reducing the risk of relapse both in the apical compartment of the pelvic floor and in the access area, that is, in the area of the posterior wall of the vagina;

- to prevent prolapse relapse when lowering the anterior compartment of the pelvic floor;

- reduce the number of repeated surgical interventions;

- reduce the risk of such postoperative implant-associated complications as suppuration of the endoprosthesis in the tissues, as well as erosion of the vaginal mucosa;

- increase the safety of the operation by reducing the risk of damage to the internal structures of the pelvis (rectum, bladder, large vessels).

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17. http://nelaton.ru/surgery/setki-uroginekologiia/urosling-1-linteks.

Claims (2)

1. A method for surgical reconstruction of the pelvic floor, including the vaginal installation of a polypropylene mesh endoprosthesis-tape with bilateral excretion of its distal ends using a tunnel made through incisions made on the skin of the perianal region under the ischial tubercles for 4 and 8 hours in the middle of the distance between the coccyx and the outer sphincter of the anus, lateral from the last, and fixation of the aforementioned endoprosthesis-tape to the cervix, characterized in that a seamless knitted mesh endoprosthesis-tape with atra with a 15 mm wide macroporous structure, UroSling-1, Linteks is installed through the front access when lowering the anterior compartment of the pelvic floor or the posterior approach when lowering the posterior compartment, passing the specified endoprosthesis through the tunnel, which is a symmetrical single-row metal spiral that is wound round to a turn, with a diameter 1 mm larger than the diameter of the conductor, and covered on the outside with a polypropylene sheath, held in the sciatic-rectal space 5 cm laterally from the outside about the sphincter of the anus through the sacral-spinous ligaments "outside-in" with a curved metal conductor, made in the form of a pin with a lead into the access area, then the aforementioned endoprosthesis is fixed with three sutures to the cervix using a non-absorbable bioinert thread, leaving the ends threads of one of the seams, after which colporography is performed in the compartment corresponding to the produced access by applying a subfascial continuous seam using a non-absorbable bioinert thread, followed by binding of the left ends of the threads of one of the three sutures that fixed the endoprosthesis to the cervix with the suture of the colporrafic suture. 2. The method according to p. 1, characterized in that when applying a subfascial continuous suture with a thinned vaginal wall, an absorbable thread is used.

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