METHOD OF SPHINCTEROLEVATOROPLASTY WITH AUTOLIPOGRAFTING

Claims

1. The method of surgical treatment of post-traumatic defect of the sphincter apparatus of the rectum is performed under combined anesthesia, including spinal anesthesia and perianal block, then a horizontal incision of the skin of 4-6 cm of the perineum is made in the projection of the perineal body or cicatricial tissues, dissection is performed in the cranial direction in the thickness of the perineal scar without its excision, mobilizing the anoderm and the wall of the lower ampullar part of the rectum from the vaginal wall and continues in the proximal direction to the middle third of the vagina or until the visualization of the laterally diverging "legs" of the puborectalis muscle, in the lateral direction the edges of the damaged sphincteric framework are mobilized until it is possible, with simultaneous medial traction, to form an overlap of the edges of the mobilized sphincteric complex without pronounced tension of 1-2 cm,then the mobilized flaps are sutured with 4-6 U-shaped sutures with absorbable monofilament thread 2 / 0-3 / 0 using the "coat" technique, then the transverse perineal muscle and skin are sutured vertically in a single block with the formation of a "high perineum", then autologous material is collected from the subcutaneous fat tissue on the inner surface of the lower third of the thigh, then preliminary hydropreparation of the adipose tissue is carried out using 20 ml of a solution containing 17.85 ml of 0.9% saline with 2.0 ml of local anesthetic diluted in it, 0.15 ml of adrenaline hydrochloride 0.01% and after a 15-minute exposure, material is collected with a Tonnard sampling cannula of the "grater" type for micro- and nanolipofilling, connected to a collection device in the form of a 20 mm syringe, as a result, 40 to 70 ml of adipose tissue are aspirated, then the collected material washed with saline solution and emulsified until a homogeneous emulsion is obtained,Next, autotransplantation of adipose tissue is performed using a 20-50 ml syringe and a cannula through 3-4 mm incisions on the skin of the perianal area, first introducing microfat under manual control into the submucosal layer of the anal canal at the level of the anorectal junction, in the projection of the puborectal loop at 3, 6, 9 and 12 o'clock positions of the conventional clock face, 10±2 ml at each point, and then 20-25 ml of nanofat is introduced through the gap between the matched skin edges under the muscle tissue suture formed during sphincteroplasty.

2. The method according to paragraph 1, characterized in that preliminary hydropreparation of adipose tissue is carried out using 20 ml of a solution containing 17.85 ml of 0.9% saline with 2.0 ml of local anesthetic and 0.15 ml of 0.01% adrenaline hydrochloride diluted in it, and after a 15-minute exposure, material is collected.

3. The method according to paragraph 1, characterized in that the collected adipose tissue is washed with a physiological solution and emulsified using adapters with diameters of 2.4 mm, 1.8 mm, 1.2 mm, mechanically moving the lipoaspirate between two syringes of 20-30 ml 10 times with each adapter until a homogeneous state of the emulsion is obtained, obtaining 40-45 ml of adipose tissue microfraction.

4. The method according to paragraph 1, characterized in that a Tulip nanotransfer 600 / 400 micron filter with a special metal cartridge is used to obtain 20-25 ml of fat nanofraction.