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POSSIBILITIES OF THE IMPLEMENTATION OF SURGICAL INTERVENTIONS AIMED AT CORRECTING THE PROLAPSE OF PELVIC ORGANS, IN THE CONDITIONS OF THE GYNECOLOGICAL DEPARTMENT OF THE MUNICIPAL MATERNITY HOSPITAL


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Abstract

Introduction. Prolapse of pelvic organs is a polyethological disease, manifested by the displacement of the uterus and the walls of the vagina to the vulvar ring or out of it. At the base of this pathology, there is the functional inconsistency of the ligament apparatus of internal genital organs and pelvic floor musclesoccurring due to the impact of various physical, genetic, psychological, age, hormonal, iatrogenic etiological factors. Prolapse of the pelvic organs is an actual problem due to the high incidence of both reproductive and elderly women. This article considers the effectiveness of criteria for selection patients with different degrees of prolapse of the genitals for the implementation of surgical correction in conditions of the gynecological department of the municipal maternity hospital. Material and methods. The sample included patients with initial, post-hysterectomic, recurrent anterior and apical prolapse of the genitalia of II-IV degree according to POP-Q classification in the age cohort of 45-70 years who do not have systemic diseases, or with a compensated systemic disease that does not introduce significant limitations in physical and social activity. Depending on the severity of pelvic prolapse, patients underwent various types of surgical treatment. In 5 patients with incomplete uterine prolapse, there was performed laparoscopic extraperitoneal ligature hysterosuspension and vaginal wall plasty using reticular implants, and in the 1 patient with the complete prolapse of the uterus, there was made the vaginal extirpation of the uterus with extraperitoneal colposuspension vaginal walls plasty using a reticular implant. Women with adjacent gynecological pathology (24 patients) underwent laparoscopic (22) and laparotomic (2) operations for the main disease and the plasty of the vaginal walls (including 19 patients using reticular implants). In one case, a patient with elongation of the cervix and the lowering of the anterior wall of the vagina there was performed a modification of the Manchester operation using a reticular implant. In 3 patients with the isolated prolapse of the anterior wall of the vagina, the vaginal wall plasty was made with the installation of a reticular implant. Results. After the surgical interventions, no intraoperative, as well as early or late postoperative complications were noted. The evaluation of the effectiveness of the performed surgical treatment according to follow up in the period of from 12 months to 5 years, revealed 1 case of the recurrence of the disease in the form of cervical stump prolapse in a 58-year-old patient managed with succeed promonofixation of the cervical stump with a reticular implant. Conclusion. The high anatomical (94.4%) and functional (96.8%) efficacy of the surgical treatment of the prolapse of pelvic organs allow judging the persuasiveness of selection criteria for surgical correction of the genital prolapse in conditions of the gynecological department of the maternity hospital.


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