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    This content was uploaded by our users and we assume good faith they have the permission to share this book. If you own the copyright to this book and it is wrongfully on our website, we offer a simple DMCA procedure to remove your content from операции site. Start полип pressing the button below! Pitts, Roger P. Meyer, George F. Stulbarg, Timothy D. Lake, Bruce F. Scharsch-midt, Rebecca W. Van Dyke, Полип. Gregory Fitz, John R.

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    The invention relates to medicine, operative gynecology, in particular, to the treatment of enterocele, including with or after hysterectomy. Pelvic organ prolapse is a common pathology that negatively affects the quality of life, adversely affecting the social, psycho-emotional and sexual spheres of women.

    In после structure of gynecological morbidity, the share of pelvic prolapse accounts for Adamyan et al. In addition to pelvic organ prolapse VETpelvic floor insolvency syndromes include cystocele, urethrocele, enterocele опеерации rectocele see [2] Msd Handbook Professional version. Article by S. These disorders include protrusion of the corresponding organ in the vagina: cystocele bladderurethrocele urethraenterocele операции intestine and peritoneum and rectocele rectum. Symptoms include a foreign body sensation and pressure in the pelvic area and vagina.

    There are three basic surgical techniques for the abdominal correction полип enterocele - Moshkovich, Galban and plication of the sacro-uterine ligaments, providing for obliteration of the rectal uterine cavity. Operational gynecology: Atlas. In the work после Kamoeva S. It was shown, in particular, that the Elevate posterior supports the posterior and apical pelvic floor. The Elevate system implants allow the mesh implant to be fixed by means of self-locking tips and special needle-guides bilaterally in the area of the internal obturator muscle Elevate anteriorto the levators and side walls or the dome of операции vagina Elevate posterior and sacral-spinous ligaments bilaterally.

    According to Shkarupa D. Known methods of surgical treatment of genital prolapse in women, including enterocele, using mesh technologies that show significantly better results than without mesh implants [6] Larsen WI, Yavorek TA. A method for surgical treatment of post hysterectomy vaginal prolapse матке the background of perineal prolapse syndrome.

    The method includes the selection of the sacro-spinous ligaments from two sides through the perforations from the side of the vaginal canopy, their матке, then the mucosa of the anterior and posterior walls of the vagina is cut along the midline, 1. In accordance with the method, sacrovaginopexy операуии performed, correction of the prolapse of the posterior vaginal wall using a mesh prosthesis, and when performing sacrovaginopexy to the transverse presacral ligament with non-absorbable sutures, a mesh prosthesis is fixed, consisting of two sections fixed between each other - one cm, the second see, bring together and fix the sacro-uterine ligaments and upper bundles of muscles that lift the anus, and fix them to the mesh prosthesis, then into the vagina through the posterior colpotomy you a prosthetic flap is inserted, it is freely placed on the front wall of the rectum поллип the posterior commissure, thereby creating neofascia to replace the полип recto-vaginal fascia, after which the integrity of the vaginal mucosa is restored by separate absorbable ligatures.

    The main disadvantages of the considered analogues is that they solve a different problem, полип with the claimed method. Known methods allow correction of the prolapse of the anterior and posterior walls of the vagina, cystocele or rectocele, but they are not directly suitable for the treatment of enterocele, since there are no corresponding steps aimed at correcting enterocele.

    In addition, in the process of operational actions, the lack операции visual control and observation операцио the passage of conductors through the tissues of the body can lead to damage and trauma to neighboring операции and tissues or to interoperative bleeding. A method for surgical treatment of a vaginal enterocele, including a midline incision of the mucous membrane of the больничный wall of the vagina, dissection and removal of the hernial sac into the после, opening of its apex, reduction into the abdominal cavity of its contents, dressing at the послр, cutting off матке reduction of the stump into the abdominal cavity with subsequent suturing of the vaginal wound with nodal catgut sutures.

    A method for surgical treatment of enterocele with после access, including the isolation of a hernial sac, the opening of its apex, the application of a purse string suture on the neck of the hernial sac.

    In this case, a purse string suture is made from non-absorbable thread, and a flap from the Mycro Mesh Plus mesh is fixed to the peritoneum of the supporting полип by a non-absorbable опеоации. The disadvantages of these analogues is that measures to strengthen the pelvic больничный are limited to private, palliative solutions and do not have a complex, combined nature.

    In the больинчный period of use of analogues, it is possible to limit the mobility of the pelvic organs of patients due to the attachment of implants directly to adjacent tissues without the use of болоничный implants. In [5] Shkarupa D.

    In particular, Fig. This operation is больничынй performed laparoscopically. It involves supravaginal amputation of the uterus the cervix is preservedafter which a surgical mesh is sutured to the muscles of the pelvic floor to the cervical stump, anterior and posterior walls of the vagina, and also in a number of modifications, which is fixed to the sacrum with the other end.

    As a result, the vagina is "suspended", and due to this it is kept inside. All больничный technologies Elevate, Pelvix, Calistar, etc. For example, obstructive membranes in the anteromedial region may be additional fixation points. The lack of analogue. The analogue is a methodological manual, which discusses the general principles for the treatment of diseases associated полип VET, enterocele and, during specific operations in patients with a specific diagnosis, can only serve as a methodological guide.

    Additionally, at the stage of laparoscopy and under its control, with the help of two conductors from после place of entry of the trocars to the left and right, extraperitoneal channels are formed to оперсции base of the stump of round uterine ligaments, the channels are formed further into the vagina, операции conductors are left in the channels, they are desufulated, the trocars are removed. The mucous membrane of the vaginal wall and skin are sutured with separate absorbable sutures. At the same time, vikril filaments are used as absorbable suture material, prolenium filaments are used as non-absorbable suture material, proline is used as mesh implant material, and at the stage of restoration of the posterior vaginal wall, four sutures опарации applied to the после muscles supporting the anus.

    The disadvantages of the prototype include insufficient strengthening матке the supporting apparatus of the pelvic organs in the lateral directions. Due to the elongation of the supporting elements of the pelvic organs implant, sleeves, ligatures in the vertical direction, with операции physical activity of the patient, a lateral displacement of the structure with the implant, repeated prolapse and relapse of the disease are possible.

    The objective of the development of the proposed method for simultaneous two-level correction of enterocele with laparovaginal access is to increase the effectiveness of surgical treatment of enterocele, reduce the risk of damage to tissues and organs больничный the pelvis and, thereby, reduce relapse of the disease. A feature of the method is полип clarify the area of criteria by which it is proposed to матке it for the treatment of матке, in order to матке the risk of possible relapse of the disease.

    The work was carried out in the clinic of obstetrics and gynecology named after V. Snegireva - the clinical base of the Department of Obstetrics and Gynecology No. According to the results of a comprehensive examination of patients who applied for relapse of pelvic organ prolapse years опеерации the first surgical intervention, they were divided into two groups depending on the volume of the previous operation.

    The first group included patients after total hysterectomy by vaginal and laparotomy approaches with simultaneous correction of cystocele using mesh implants. The second group consisted of patients after organ-saving operations on the pelvic organs in combination with uterine ventilation by aponeurotic flaps and. The age of patients was in the range: years. All patients were in the postmenopausal period, the duration of which varied from two years to 21 years. Criteria for inclusion in the work were isolated forms of enterocele after previous surgical interventions, accompanied by correction of various types of pelvic prolapse.

    Матке criteria were: combination of enterocele with other types of pelvic organ prolapse, severe extragenital pathology, absolute contraindications for laparoscopy. The technical result опепации achieved by multipoint fixation of two mesh implants to the natural physiological supporting elements of the pelvis. The second implant операции shape, close to a rectangle with больничный lateral sleeves, the specified sleeves are fixed to the sacro-spinous ligaments on both sides, and the second implant is placed on top of the posterior больничныф of the cervix, to the posterior fornix or to the dome of the vagina and to the distal end the first после, and from the bottom to the после fascia of patientswhile each of the implants performs its support function.

    Such fixation helps to prevent the displacement, twisting and wrinkling of the implants, which increases the efficiency of the pelvic support apparatus, improves the outcome of the operation to eliminate enterocele and ensures the long-term операциии effect. Reducing the risk of damage to tissues or adjacent organs после a minimum is ensured by the fact that the entire operation is carried out under strict laparoscopic and video оперкции control, including using laparoscopic transillumination diaphanoscopy.

    As a result, the операции of interoperative bleeding is reduced, the intraoperative effect on organs and tissues of the body is minimized, the possibility of postoperative complications and relapse of the disease is reduced. The proposed method, which provides reliable rehabilitation of such patients, has not only medical, but also social significance - improves the health больничный quality of life of women.

    The specified inventive больничный for simultaneous two-level correction of enterocele with laparovaginal access is presented in two embodiments: for the first and second groups of patients. The operation is usually performed under general ETN or epidural anesthesia other methods of analgesia may be used. The patient is placed on the operating table in a lithotomy position. The surgical field is treated with antiseptic solutions, then полип bladder is catheterized, as well as other known preparatory steps.

    The inventive method for the simultaneous two-level correction of enterocele матке laparovaginal access for the first group of patients is that after a previous total hysterectomy is performed through vaginal and laparoscopic access. In this case, in particular, as a resorbable suture material, threads of vicryl are used. In this case, as non-absorbable suture material, filaments of prolene or type etibond are used.

    At the same time, the Elevate posterior posterior system can be used as the second implant. Also, the inventive method for the simultaneous two-level correction of enterocele with laparovaginal access for the second group of patients is that they perform vaginal and laparoscopic access.

    Kolpoperineolevatoroplasty is операции, and absorbable or non-absorbable suture material is used to stitch tissues. The difference between the method is that laparoscopic access performs the evacuation of the contents of the hernial sac, consisting of the peritoneum of the Douglas pocket and the wall of the posterior больничный fornix.

    In FIG. All patients were divided into two groups depending опарации the volume of the previous operation. So, the first group included 13 patients after total полип by vaginal and laparotomy approaches with simultaneous полип of cystocele using mesh implants. The second group consisted of 10 patients after organ-saving operations on the pelvic organs in combination матке uterine ventilation by aponeurotic flaps and colpoperineoleoplasty.

    When examining patients to determine the degree of prolapse of their pelvic organs used больнисный international classification of quantitative assessment of VET Pelvic organ prolapse quantification system. The average age of patients was Patient Опсле. Anamnesis of the disease: indue to incomplete prolapse of the uterus, cystocele of the 2nd degree, laparovaginal extirpation of the uterus, extraperitoneal ligature colposuspension, plastic surgery of the anterior vaginal wall using a mesh implant, coloperineorography with levatoroplasty were performed.

    During dynamic observation of the patient in the postoperative period, блоьничный gradual formation of a hernial protrusion in the area of the vaginal dome was noted. In Decemberpains in the lower полип intensified, especially with prolonged standing, discomfort мате a foreign body sensation in the perineum.

    Over the next three months, the pain intensified, difficulties associated with bowel movements, the need for laxatives, constipation joined. St Genitalis: When strained, the back of the операции prolapses to introitus and exits.

    In a больничный position, significant enterocele with loops of the small intestine is noted. According to the ultrasound data dated March 16, the dome of the vagina without features. Urethra - vesication. V-shaped sphincter. Hypermobility of the vagina. Diastasis m. Conclusion: urethral vesication, enterocele. The patient was examined, surgical treatment was recommended as planned, no contraindications were found.

    Sacrospinal correction of enterocele. I stage. Under aseptic conditions, a typical pneumoperitoneum of 4. The central trocar is introduced in the umbilical region.

    An additional 2 manipulators are under the control of a laparoscope. During diaphanoscopy: the light of a laparoscope shines through all the walls of the hernial sac, the gates of which are limited in front by the front wall of the vagina, behind the coccyx, on the sides by the ischial awns. No additional pathology in the pelvic cavity was found. II stage. Extraperitoneal promontofixation using a mesh implant.

    Sacrospinal Elevate correction of enterocele. After preliminary perineotomy and hydrotreating of the hernial sac, consisting of the peritoneum of the Douglas больничный and the wall of the posterior vaginal боллничный, a longitudinal midline section was made to dissect the vaginal mucosa above the hernial sac to the peritoneum.