RU2196518C2 - Method for surgical treatment of rectocele - Google Patents

Abstract

FIELD: medicine, surgery, proctology. SUBSTANCE: one should perorally and intravaginally inject a bactisporin preparation in preoperative period. An access is used by splitting a rectovaginal septum. Rectal wall should be corrugated, anus-lifting muscles should be sutured. An autodermal fragment is fixed above sutures. EFFECT: improved prophylaxis of relapses. 1 ex, 1 tbl

Description

 The invention relates to medicine, namely to surgery and proctology, and can be used for surgical treatment of rectocele.

 One of the important tasks of coloproctology is the surgical treatment of rectocele. Most often, the method developed by the staff of the Research Institute of Proctology (V.D. Fedorov, V.D. Dultsev. Proctology, -M.: Medicine, 1984, p.29, 140) is used to treat this disease, which is as follows. The operation is performed under general anesthesia. The patient’s position on the operating table with the lower extremities bent to the sides and bent at the knee and hip joints. A triangular flap of the posterior wall of the vagina is cut out, which is detached. The front wall of the rectum is corrugated in the longitudinal direction by individual catgut sutures without piercing the intestinal mucosa. The second row of sutures is used to suture the muscles that raise the anus, previously in the acute way, isolating them from the surrounding tissues. The disadvantage of this operation is the high frequency of relapses and infectious complications from 5.3 to 16%.

 The technical result is to increase the effectiveness of treatment and prevention of relapse.

 The method is as follows. 5-7 days before surgery, the drug "Baktisporin" is used to correct vaginal microbiocenosis (Dry bactisporin is a lyophilized living bacteria Bacillus subtilis strain 3H), which has bactericidal and fungicidal effects (tampons in the vagina for 2 hours, daily). In addition, "Baktisporin" is administered orally at a dose of 2-3 times a day to correct intestinal dysbiosis.

 The operation is performed under general anesthesia. The patient’s position on the operating table with the lower extremities bent to the sides and bent at the knee and hip joints. The first step is to cut out an autodermal flap from the medial surface of the thigh. Processing the flap is carried out according to Yanov V.N. Next, the rectovaginal septum is split, the muscles of the levators are secreted. The front wall of the rectum is corrugated in the transverse direction with separate catgut sutures without piercing the intestinal mucosa. The second row, with acrylic sutures, sutures the muscles that raise the anus, having previously sharply selected them from the surrounding tissues. An autodermal flap is cut out to the desired size and its ends are fixed on top of the vicryl joints. Muscles - levators are laid on top of the transplant.

 This method has several significant advantages in comparison with the known. Our morphological studies have established that the autodermal flap has immunomodulating properties, in addition, it performs a skeleton function. Of no small importance is the effect of "Baktisporin" on the state of the local macrophage immunity, as a result of which indirectly affects the colonization of the colon mucosa, in biopsy specimens in patients who were treated according to the developed method.

 This method was applied in 28 patients, who, thanks to the proposed method, managed to reduce the treatment time from 13-20 days to 12-14, compared with patients in the control group (22 people) (table).

 When using this method in patients of the main group of complications was not observed, all patients received a good and excellent result. Relapse of the disease was not observed for 3 years.

 Clinical example. Patient T., 42 years old, case history N 13678, was admitted to the clinic in a planned manner with a diagnosis of rectocele 3 tbsp. The diagnosis was verified by sigmoidoscopy, irrography, sphincterometry. 5 days before the operation, the drug “Baktisporin” was used (tampons in the vagina for 2 hours, daily). In addition, "Baktisporin" was administered orally at a dose of 2-3 times a day to correct intestinal dysbiosis.

 The operation was performed under general anesthesia. The first stage was an autodermal flap cut from the medial thigh. The flap was processed according to V. N. Yanov. Next, the rectovaginal septum was split, the levator muscles were isolated. The front wall of the rectum was corrugated in the transverse direction by separate catgut sutures without piercing the intestinal mucosa. The second row, with acrylic sutures, the muscles that lifted the anus were sutured previously by the sharp path, separating them from the surrounding tissues. An autodermal flap of the required size was cut out and its ends were fixed on top of the vicryl joints. Levator muscles were placed on top of the transplant.

 Examined after 1.3 years, there was no relapse of the disease.

Claims (1)

 A method of surgical treatment of rectocele, including oral and intravaginal administration of bactosporin in the preoperative period, access by splitting the rectovaginal septum, corrugating the rectal wall without piercing the mucosa, suturing the muscles that raise the anus, and fixing the autodermal flap over the sutures.

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