METHOD OF ENTEROCELE SURGICAL TREATMENT WITH CYSTOCELE AND RECTOCELE, ACCOMPANIED BY PROLAPSE OF UTERUS OR VAGINA VAULT

摘要

FIELD: medicine; surgery. ^ SUBSTANCE: carry out inferomedian laparotomy. Mobilise the rectum using mesorectum up to the pelvic floor muscles with mobilisation of a vagina posterior wall to a pelvic diaphragm. Place a prolene grid in a wound in quality of alloplastic implant and fix the grid to the sacropromontory. After raising and turning, fix the rectum to the prolene grid. The distal stretched part of the prolene grid is dissected in the middle forming the "trousers". Fix the right and the left "trouser-legs" to the rectum with the subsequent fixation to forward levators in places of their attachment to a periosteum of sciatic and pubic bones. Exsect the excess of a posterior wall of the vagina with the subsequent level-by-level restoration of the vagina wound by separate seams. Carry out a turn of the mobilised straight line of a muscle of a stomach on 180°. Impose two ligatures on the cut proximal part of a muscle. The ligatures through the separate cuts in length to 1 cm in projections of internal edges of sciatic hillocks are spent blunt by clamps through punctures in the anterior levators. The ligatures are deduced on a perineum skin. Reduce an abdominal rectus muscle for ligatures in a cavity of a small pelvis between the vagina and the rectum. Fix ligatures to a periosteum of internal surfaces of sciatic hillocks. Tighten up the vagina and fix to the abdominal rectus muscle reduced in a pelvic cavity. Take in an abdominal cavity layer by layer, leaving drainages in a cavity of the small pelvis. Mobilise the bladder, a proximal part of a urethra and tighten up on an internal surface of pubic bones. File the necks of a bladder of a ligature imposed on lateral surfaces to an internal surface of upper edges of a periosteum of pubic bones. Enter into the proctal channel a circular proctal dilator and impose on a forward semicircle of a rectum above a gear line 2-3 semi-purse-string suture with capture mucic-submucosal layer. Tighten the semi-purse-string suture on a head of the apparatus with the subsequent underrunning of the apparatus of mucous-submucosal rectum layer. Similarly stitch back the rectum semicircle. ^ EFFECT: possibility to liquidate ptosis of organs of small pelvis, to carry out their reliable bracing to osteal structures of the pelvis, to strengthen the muscular diaphragm of small pelvis with simultaneous normalisation of the certificate of a defecation and emiction, to liquidate feeling of discomfort and to exclude enterocele relapse. ^ 2 ex