RU2422103C1 - Method of fistuloraphy - Google Patents

Abstract

FIELD: medicine. ^ SUBSTANCE: invention relates to medicine, namely to urology. Demucosation of vagina mucosa is performed. Sutures, adapting fistula to posterior wall of vagina, are applied. Vagina mucosa is sewn. Scar tissues are dissected on the entire depth of fistula without removing Foley catheter from fistula. On lateral sides of fistula vertical mattress Donati sutures are applied. Catheter is removed. Fistula is sewn by additional vertical mattress sutures with 3-4 mm step. Second row of sutures is formed, for which purpose with one end of thread of each first row suture posterior wall of vagina is sewn with stitch length 5-7 mm, by the other end of thread of each first row suture sewn is anterior wall with stitch length 3 mm. Threads are tied up and cut off. ^ EFFECT: method makes it possible to ensure good adaptation of sewn fistula to posterior demucosed wall of vagina, which excludes urea penetration and formation of closed cavities in operation zone. ^ 1 cl, 6 dwg

Description

The invention relates to medicine, namely to urology, and consists in a method for closing post-hysterectomic vesicovaginal fistulas.

A known method of plastic surgery of the vesicovaginal fistula according to the patent of the Russian Federation No. 2135039, including suturing the wall of the bladder and vagina. At the first stage - transcystic - a median incision is made, a revision of the bladder, a circular incision, slightly departing from the edges of the fistula, ligature around the fistulous opening and fixing them to the catheter, with which they are removed through the fistulous passage towards the vagina. The stage is completed by suturing Donatti on the renewed edges of the fistulous passage and suturing the bladder. At the second, extravaginal, stage, the scar tissue of the fistulous course is excised and a Donatti suture is placed on the vaginal wall.

The disadvantage of this method is the complexity of its implementation and increased invasiveness.

The prototype of the invention may be a high partial colposcleisis according to Latzko - the technique is described in the monograph "Operative Gynecology" X. Hirsch and others - Moscow: "GEOTAR-MED", 2004. - S. 495-496. The method of high partial colposisis according to Latzko is as follows: eccentrically (relative to the fistula) demucose the front and back walls of the vagina. Then a series of muscle sutures are applied that adapt the fistula to the posterior wall of the vagina. Then sutured the mucous membrane. However, the described method has several disadvantages:

1) an unsteady fistula causes the flow of urine into the area of the operation, especially during the mixing;

2) the resulting cavity (which can be considered as a diverticulum of the bladder) can be a place of stagnation of urine and a prolonged course of the inflammatory reaction.

The objective of the invention is to exclude the formation of a cavity communicating with the bladder, and to ensure the adaptation of the fistula to the posterior wall of the vagina.

The objective of the invention is achieved by the fact that after demucosis of the vaginal wall along the edge of the fistula to the entire depth remove scar tissue. On the fistula to the entire depth of the tissues in the transverse direction (relative to the axis of the vagina), Donati vertical mattress sutures are applied, forming the first row of sutures. Then form the second row of sutures, for which the ends of the threads of the first row of sutures stitch the front and back walls of the vagina. In this case, the line of the first suture adapts to the posterior wall of the vagina. Following this, the vaginal mucosa is sutured.

Features:

1) impose, without removing the catheter, on the lateral sides of the fistula the first row of vertical mattress sutures, which, on the one hand, adapts its edges, and on the other, prevents excessive tension and trauma to tissues, in comparison with methods when separately, and especially multidirectional , the walls of the bladder and vagina are sutured (Atabekov’s operation. “Atlas of urogynecological operations” D.P. Chukhrienko et al. - Kiev: “Vishcha school”, 1981. - P.144-145);

2) form the second row of sutures, for which one end of each thread of the first row of sutures sutures the posterior wall of the vagina, the other end of the thread - the front wall,

3) tie the threads, reliably adapting the sutured fistula to the posterior wall of the vagina, which eliminates the formation of closed cavities.

The invention is illustrated by the following drawings:

figure 1: high partial colposisis according to Latzko - demucosis of the vaginal mucosa;

figure 2: high partial colposisis according to Latzko - the imposition of a number of muscle sutures;

figure 3: high partial colposisis according to Latzko - the final view after suturing of the vaginal mucosa;

figure 4: method of fistulography - the imposition of the first row of vertical mattress sutures Donati;

figure 5: method of fistulography - the implementation of the second adaptive row of sutures;

6: method of fistuloraphy - the final view in the sagittal plane.

The method is as follows.

The vaginal mucosa is excised eccentrically relative to the fistula 1 in the ratio of the area of the front and back walls of the vagina 1: 2 (figure 1). Scar tissue along the edge of fistula 1 is excised to the entire depth. This stage of the operation is facilitated by the use of scissors with curved cutting parts along the edge and plane and traction using a Foley catheter inserted into fistula 1. Without removing the catheter, vertical mattress sutures of Donati 2 are placed on the lateral sides of fistula 2 with absorbable suture material 2-0 - 3- 0. The catheter is removed. The fistula 1 is sutured with additional vertical mattress sutures 3 (Fig. 4) in increments of 3-4 mm, using the superimposed sutures 2 as holders. The threads of the first row of seams do not cut. Then a second row of sutures is formed, for which the back wall of the vagina is sutured with one end of the suture of each suture of the first row, while the length of the stitch 4 is usually 5-7 mm, depending on the thickness of the walls of the bladder and vagina in the fistula area. The other end of the thread is sutured to the front wall of the vagina, the length of the stitch 5 is 3 mm (figure 5). When tightening, the line of the first seam adapts to the back wall. The threads are tied, cropped. Sutured the vaginal mucosa (Fig.6).

According to the proposed method, 14 operations were performed for 13 women, since one patient had a relapse of the fistula due to the early onset of sexual activity (8 days after the operation).

Thus, this method of fistuloraphy can be recommended for clinical use in urology in the treatment of post-hysterectomy vesicovaginal fistulas. This method provides a good adaptation of the sutured fistula to the posterior demucous wall of the vagina, which excludes the entry of urine and the formation of closed cavities in the area of operation.

Claims (1)

A method of fistuloraphy, including demucosis of the vaginal mucosa, suturing, adapting the fistula to the posterior wall of the vagina, and suturing of the vaginal mucosa, characterized in that after excision of the scar tissue to the entire depth of the fistula without removing the Foley catheter from the fistula, vertical matres are placed on the lateral sides of the fistula Donati sutures, remove the catheter and suture the fistula with additional vertical mattress sutures with a step of 3-4 mm, then form a second row of sutures, for which one end of the suture of each suture of the first row is sutured a rear wall of the vagina was 5-7 mm stitch length and the other end of each suture thread of the first row is sewn stitch front wall 3 mm long, thread knotted and cut.

Images