RU2106114C1 - Surgical method for treating rectovaginal fistula - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves separating vaginal posterior wall from the rectal anterior one. The fistula duct is transected. The fistula duct stumps are turned inside out into the lumen of the vagina and rectum. Clips from titanium nickelide possessing shape memory properties are put below the fistula duct base. Porous plates from titanium nickelide impregnated with antibiotics are placed into retrovaginal septum. EFFECT: reliable separation of the lines of rectal and vaginal sutures.

Description

 The invention relates to medicine, specifically to surgery, and relates to methods for surgical treatment of rectal-vaginal fistula.

 Known methods of surgical treatment of rectal-vaginal fistula by excision of the fistulous course [1].

 These methods do not exclude a number of postoperative complications in the form of discrepancies in postoperative sutures, suppuration of a postoperative wound and, as a result, relapse of the disease.

 Closest to the proposed method is the method [2], which is carried out as follows.

 The posterior wall of the vagina is separated by a transverse section from the anterior wall of the rectum. Maximum mobilize the back wall of the vagina and the front wall of the rectum. Cross the fistulous course. Sutured hole in the wall of the rectum and vagina. A sialovial mesh is placed in the recto-vaginal septum and fixed to surrounding tissues. Sew the wound in the transverse direction.

 This method also has the above postoperative complications and lead to a relapse of the disease.

 The aim of the invention is to eliminate postoperative complications due to reliable separation of the line of intestinal and vaginal sutures with a biocompatible implant made of porous titanium nickelide and the creation of a local depot of antibiotics.

 The goal is achieved by the fact that according to the method of surgical treatment of rectal-vaginal fistulas, the posterior wall of the vagina is separated by a transverse section from the anterior wall of the rectum, mobilize them as much as possible, cross the fistulous passage, turn the stumps of the fistulous passage into the lumen of the vagina and rectum, apply titanium nickelide clips with a shape memory effect on the stump base, a titanium nickelide plate impregnated with antibiotics is placed in the rectovaginal septum.

 What is new in the invention is that the stumps of the fistulous passage are turned into the lumen of the vagina and rectum, clips of titanium nickelide with shape memory effect are placed below the base of the fistulous passage, and a porous titanium nickelide plate impregnated with antibiotics is placed in the rectovaginal septum.

 Thus, the invention meets the criteria of "novelty", "industrial applicability", as it has been successfully tested in gynecological and hospital clinics of SMU. In the literature we have analyzed, which has become generally available in the world before the priority date of the invention, the proposed technical solution does not explicitly follow for the specialist, thus, it meets the criterion of "inventive step".

 The method is carried out in the following way.

 The posterior wall of the vagina is separated by a transverse section from the anterior wall of the rectum, the fistulous passage is crossed and suture-holders are placed on the stump. Introducers of hollow organs are introduced into the lumen of the vagina and rectum. The stumps of the fistulous passage are turned out into the lumen of the vagina and rectum, and clips below the base of the fistulous passage are made of titanium nickelide with shape memory effect. Then, a plate of porous titanium nickelide impregnated with antibiotics is placed in the recto-vaginal septum. The wound is sutured tightly in the transverse direction.

 Patient S. was admitted to the gynecological clinic of SMU in November 1993 with a diagnosis of rectal-vaginal fistula. After preoperative preparation, consisting in sanitation of the vagina, under the patient's epidural anesthesia, an operation was performed to close the rectal-vaginal fistula.

 After processing the surgical field, the posterior wall of the vagina is separated from the front wall of the rectum by a transverse section. The fistulous course is withdrawn and crossed. On stump of a fistula seams-holders are imposed. In the lumen of the vagina and rectum, dilators of the lumen of the hollow organs are introduced. Then the stumps of the fistulous course are turned out over the suture-holders into the lumen of the vagina and rectum. Below their base, in a cooled state, clips of titanium nickelide with shape memory effect are superimposed. A porous plate of titanium nickelide in the form of a fistulous opening, impregnated with broad-spectrum antibiotics, was introduced into the rectovaginal septum. The wound is sutured tightly in the transverse direction. In 7 days sutures removed, wound healing by primary intention. At 6 months after surgery, a relapse of the disease was not noted. The patient does not show complaints.

 The replacement of the traditional suture material (catgut, silk, thin capron) with titanium nickelide clips with a shape memory effect is due to the absence of incompatibility with surrounding tissues in the latter reaction, which was histologically proved in an experiment with a large experimental material. This eliminates the inflammatory response of tissues, wound divergence. The shape memory effect makes it possible to reliably block the fistulous passage, which is achieved due to the compression that develops when the clips are heated to body temperature, and thereby excludes the spread of infection.

 The use of a porous plate causes its germination by surrounding tissues and excludes the communication of lines of intestinal and vaginal sutures with each other, in addition, the impregnation of the plate with broad-spectrum antibiotics allows their local depot to be created, which in turn prevents the spread of infection. All of the above factors are the key to a successful outcome of the operation and exclude complications such as suppuration of the postoperative wound, divergence of sutures, rejection of the implant and relapse of the disease.

 The positive effect of the method consists in the absence of an incompatibility reaction from the titanium nickelide construction, the possibility of sprouting of the porous plate by surrounding tissues, which makes it possible to reliably separate the lines of intestinal and vaginal sutures, the possibility of creating a local depot of antibiotics that prevents the spread of infection and excludes postoperative complications in the form of suppuration of the postoperative wounds, discrepancies in sutures, rejection of the implant, relapse of the disease.

 Literature.

 1. Protsenko V.M. Surgical treatment of intestinal-vaginal fistula. Dis. Dr. med. Sciences - M., 1991.

 2. Yeltsov-Strelkov V.I. The use of alloplastic materials in some gynecological operations. Dis. Dr. med. Sciences - M., 1967.

Claims (1)

 A method of surgical treatment of rectal-vaginal fistula, including a cross-sectional separation of the posterior vaginal wall from the anterior rectal wall, intersection of the fistulous passage and suturing of the wound in the transverse direction, characterized in that the stumps of the fistulous passage are turned into the lumen of the vagina and rectum, nickelide clips are applied a titanium with a shape memory effect below the base of the fistulous passage and a porous titanium nickelide plate impregnated with antibiotics is placed in the rectovaginal septum.