Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_207_библиотеки_им_акад_М_И_Перельмана
.pdf
OUTCOME: RESULTS AND COMPLICATIONS
The overall satisfaction is reported as 80% to 100%. Hojsgaard and Villadsen
13
report in their series of 26 patients a
successful complete attachment of the graft within a week in 33%, and after one revision in an additional 38% of patients.
In their study, rectal perforation occurred in 3.8%, bleeding and vaginal stricture in 11.5%, formation of a urethrovaginal
fistula in 7.7%, and rectovaginal fistula formation in 3.8%. In a different study, Allessandrescu et al.
14
reported on 201
patients, with the occurrence of rectal perforation in 1%, graft infections in 4%, but overall 86.3% of patients had a good
anatomic result.
Additional complications include formation of a vesicovaginal fistula, intra- and postoperative bleeding, formation of
granulation tissue (which can cause coital bleeding and leukorrhea), graft failure as well as a tendency for scarring of the
upper portion and subsequent constriction of the neovagina.
https://t.me/med1917
Surgical Management: Williams Vulvovaginoplasty
This technique was developed by Williams in 1964
15
and has since then been modified in different ways.
16
It is most
successful in women with larger labia. The skin from the labia is used to line the neovagina. It has several advantages: It is
technically simple to perform with no need for dilation postoperatively; there are no significant complications reported; and
postoperative pain was judged to be minimal. Disadvantages include that the vaginal angle is shallower, and that urine can
collect in the newly created pouch. Overall, there are few patients reported in the literature to have undergone this procedure.
https://t.me/med1917
Step 1: Vulvar skin incision
An incision is made in the vulva in the form of a horseshoe as close as possible to the hairline, including the medial side of
the labia, extending up to the urethral meatus.
https://t.me/med1917
Step 2: Reapproximation of inner skin margins
The inner skin margins are reapproximated with 3–0 polyglycolic acid sutures. The knots are tied on the inside of the newly
created vaginal lumen. Originally 0-chromic catgut was used, but this has been since modified.
Support is given by placing a second layer of stitches involving the perineal muscles and subcutaneous fat.
https://t.me/med1917
Step 3: Reapproximation of external skin margins
The outer skin margins of the labia are connected using interrupted sutures. This creates a 3 cm deep pouch.
https://t.me/med1917
POSTOPERATIVE CARE
A Foley catheter is placed and the patient needs to be on bedrest for 7 days to avoid traction on the stitches. Due to
inactivity, one may consider the use of anticoagulation.
The patient then uses dilators for the next 6 weeks.
https://t.me/med1917
OUTCOME: RESULTS AND COMPLICATIONS
There were no significant complications reported, but only small series of patients are available for review. This procedure
can be considered after an unsuccessful McIndoe procedure.
https://t.me/med1917
Surgical Management: Davydov Procedure
This procedure uses peritoneum for epithelialization of the neovagina. The surgical approach is simultaneously vulvar and
abdominal (either open or laparoscopic) in most reports, but can also be performed via perineal approach only.
17–19
https://t.me/med1917
Step 1: Dissection and mobilization of the peritoneum
Peritoneum from the Douglas pouch is dissected and mobilized via abdominal approach, either via standard laparoscopy or
laparotomy.
https://t.me/med1917
Step 2: Creati on of a vaginal space
A space between the urethra, bladder, and rectum is created via the perineal approach. The mid sagittal plane should be
avoided to facilitate dissection. The midline tissue bridge can be removed once the peritoneum is reached.
https://t.me/med1917
Соседние файлы в папке Библиотека им академика М.И. Перельмана