METHOD OF SIMULTANEOUS TWO-LEVEL CORRECTION OF ENTEROCELE BY LAPAROVAGINAL ACCESS (VARIANTS)

FIELD: medicine.SUBSTANCE: group of inventions refers to medicine and can be used for simultaneous two-level correction of enterocele with laparovaginal access. Through the extraperitoneal tunnel, the prepared first mesh implant is made by vaginal access with a width of up to 3 cm and a length up to 16 cm, the proximal end of which is fixed with one, two non-resorbable endosutures for the longitudinal ligament of the spine at the level of the sacropromontory, the distal end of the first implant is fixed by the non-absorbable ligature to the vaginal vault. In the process of using a ready-made or prepared the second mesh implant, which is cut from a piece of sterile mesh according to individual cutting, depending on the size of the patient's pelvis, the size of the enterocele, the second implant in shape is close to the rectangle, its longitudinal side has a variable width: from the middle to the bottom, the implant is narrowed to a width of 0.5-1.0 cm, in addition, the second implant is made with at least two arms, two of which are located on the sides of the longitudinal part of the implant, closer to the middle, and directed to the sides, mainly symmetrically to the median longitudinal line of the implant, with the help of the conductors, the arms of the second implant are fixed to the sacrospinal ligaments on both sides 2 cm medial to the sciatic spines, the wide upper edge of the second implant is sutured to the vaginal vault, to the pelvic fascia and to the first implant by separate long-absorbable ligatures, the distal narrow part of the second implant is placed on the front wall of the rectum and sutured to the rectovaginal fascia.EFFECT: group of inventions can reduce the risk of relapse.13 cl, 2 ex Группа изобретений относится к медицине и может быть применима для одновременной двухуровневой коррекции энтероцеле лапаровагинальным доступом. Через экстраперитонеальный тоннель влагалищным доступом проводят подготовленный первый сетчатый имплантат шириной до 3-х см, длиной до 16-ти см, проксимальный конец которого фиксируют одним, двумя не рассасывающимися эндошвами за продольную связку позвоночника на уровне мыса крестца, дистальный конец первого имплантата фиксируют не рассасывающимися лигатурами к куполу влагалища. В процессе операции используют готовый или готовят второй сетчатый имплантат, который выкраивают из куска стерильной сетки по индивидуальному раскрою в зависимости от размера таза пациентки, величины энтероцеле, второй имплантат по форме