COLPOPOIESIS (colpopoesis; Greek kolpos a female bosom, a vagina + poiesis production, a construction) — operation of creation of an artificial vagina.
the First operation was made in 1817 by Dyupyuitren who, trying to save the woman from sufferings owing to disturbance of outflow of menstrual blood, created the course in space between a bladder and a rectum.
K. F. Gepner in 1872 applied the piece of leather taken from a hip to a vystilka of the created vagina. Similar operation was made by K. Krede in 1884. In 1888 S. G. Shalit the channel of a vagina the free skin replaced rags across Tirsh suggested to cover (see. Skin plastics ). Later for creation of an artificial vagina began to use the thin skin rags taken by a conchotome or a dermatome; similar operations did not find application. Offered in 1934. I. D. Arrest with sotr. the technique of creation of an artificial vagina by means of fetal membranes also did not gain distribution.
V. F. Snegirev in 1892, D. D. Popov in 1909, G. Schubert in 1911 offered various techniques of creation of a vagina from a rectum. In view of complexity and existence of numerous complications these operations were rejected.
In 1907 J. Boldvin for the first time applied a small bowel to creation of an artificial vagina. Operation was followed by a large number of complications and in the next years was not applied. In 1932 M. S. Alexandrov developed operation of creation of an artificial vagina from a sigmoid colon. The most successful modification of a method is one-hose To. from a sigmoid colon, the offered E. E. Gigovsky in 1949 and the wedge applied in modern, practice.
The first attempt to use a pelvic peritoneum as plastic material belongs to D. O. Ott, however the method offered them did not find supporters.
The peritoneum as plastic material was used in various options. To. from a pelvic peritoneum was widely adopted since the plastic material used at this method has good blood supply and in the postoperative period there are no heavy complications. In modern the wedge, practice is applied the one-stage method K offered in 1969 to E. V. Kravkova and A. G. Kurbanova. from a pelvic peritoneum, at Krom need of a chrevosecheniye is excluded.
There are also methods of a vystilka of a bed of a vagina alloplastichesky materials: after creation of a bed for an artificial vagina of its wall became covered with various polymers (a grid from capron, lavsan, teflon etc.). At the same time there was an increase of an epithelium on an alloplastichesky grid and its full epithelization.
B. F. Sherstnev developed a method anemic To. He offered a special kolpoelongator. Its constant pressure created the channel by extension of fabrics between a bladder and a rectum. The technique offered by B. F. Sherstnev is applied in the presence of contraindications to operation K., in other cases it is more preferable operational methods.
the Indication to operation K. inborn lack of a vagina or its fusion owing to the postponed inflammation, injuries etc. serves. Existence of heavy extragenital pathology (e.g., cardiovascular insufficiency, diseases of kidneys, blood etc.) is a contraindication to To. Emergence of a gematometra at the functioning uterus and lack of a vagina (see. Gynatresia ) — the indication to an immediate surgery To.
Before carrying out operation the scheme a wedge, inspections shall include excretory urography (see) since such patients often have anomalies of development of an urinary system.
the Preparation for surgery depends on a method K. If it is chosen intestinal To., the patient prepares the same as for any surgery which is followed by opening of a gleam of intestines (see. Intestines, operations ).
Before To. from a pelvic peritoneum imposing is recommended pneumoperitoneum (see) for simplification of the most difficult moment of operation — search and opening of a peritoneum: the gas entered into an abdominal cavity causes reaction from a peritoneum and in a small basin the exudate which sticks out a peritoneum towards a vagina accumulates. For the best orientation perhaps also introduction to an abdominal cavity before operation methylene blue, painting a pelvic peritoneum in bluish color. To this purpose it is applied also peritoneoskopiya (see). Operative measures are carried out under an endotracheal anesthesia.
At To. from a pelvic peritoneum create the channel in rectovesical cellulose, make rather broad separating of a pelvic peritoneum from surrounding fabrics (fig. 1, 1), take a naked pelvic peritoneum long clips, open, reduce and hem to area of an entrance to a vagina (fig. 1, 2). Then create a dome of a vagina, at the same time use a rudiment of a uterus (the muscular roller) which is hemmed to a peritoneum of a rectum (fig. 1,3).
Operation one-hose To. from a sigmoid colon (across Gigovsky) it is made in two stages: on the first do a section in the field of an entrance to a vagina (fig. 2, 1), create a bed of future vagina between a bladder and a rectum, and then enter a packer to a peritoneum into this bed and strengthen a gauze tampon. The second stage — a chrevosecheniye (the section at the choice of the surgeon, but is better cross suprapubic), in time to-rogo resect the mobile site of a sigmoid colon throughout 11 — 12 cm (fig. 2, 2). The resected gut shall have good food and keep at least one arterial branch. The mesentery of a gut is cut almost to a root from the distal party less from proximal. Then make sewing up of a dome of future vagina and recovery of passability of an intestinal tube an anastomosis the end in the end or a side sideways (fig. 2, 3). The distal end of the resected gut which is previously taken in by a purse-string seam thus that the mucous membrane of a gut was screwed in a transplant is reduced in a newly created bed of a vagina after opening of a peritoneum and removal of tampons. Then the dome of a newly created vagina is sewn separate seams to a peritoneum of a basin (fig. 2, 4) and recover an integrity of an abdominal wall, a purse-string seam on the reduced gut dismiss, and the gut is hemmed to area of an entrance to a vagina. At the menstruating uterus the neck it is sewed in a dome of a newly created vagina.
After peritoneal To. the first processing of a vagina is made on 5 — the 6th days by introduction of the mirrors greased with any emulsion or borglitseriny. Also other schemes of maintaining these patients are developed: so, e.g., S. N. Davydov recommends to enter tampons with a sintomitsinovy emulsion right after operation and to change them every other day. Operation can be complicated by insolvency of seams of an anastomosis, fecal peritonitis and fistulas.
Epithelization after peritoneal To. occurs due to increase of an epithelium from the upstream side in a vagina. Upon termination of epithelization the vagina undergoes the same cyclic changes, as normal. In it existence of a stick of Doderleyn and acid medium comes to light that demonstrates that fiziol, conditions of an artificial vagina are very close to normal.
Postoperative maintaining at intestinal To. same, as after any surgery which is followed by a resection of a large intestine (a diet; antibacterial, fortifying, Transfusion therapy). At methods K., followed by opening of an abdominal cavity, but without bowel resection, the patient is allowed to get up for the 2nd day after operation. Within 7 — 8 days it is necessary to try to obtain a liquid chair to exclude a tension of seams in a dome of a vagina owing to increase in intra belly pressure at defecation.
Patients can be discharged from clinic on 12 — the 14th day after operation. Sex life is recommended to be begun not earlier than in 3 — 4 weeks.
Studying of the long-term results of treatment yielded vaginografiya (see. Kolpografiya ) showed that length and volume of a vagina at these methods K. correspond to normal. In rare instances there is a stenosis of an entrance to a vagina which, as a rule, easily is eliminated with a surgical way. Cases of pregnancy after this look are described To. Delivery at the full-term pregnancy was made by Cesarean section.
Bibliography Alexandrov M. S. Formation of an artificial vagina from a sigmoid gut, M., 1955; Are I. D ist. Operation of a colpopoiesis at an inborn aplasia of a vagina by method of change of a peritoneum of rudimentary education, Akush, and ginek., No. 2, page 88, 1963; Gigovsky E. E. Formation of an artificial vagina from a sigmoid gut, in the same place, No. 1, page 51, 1949; Davydov S. N. Peritoneal colpopoiesis, L., 1977, bibliogr.; Kapelyushnik N. L. Alloplasty of an artificial vagina, Akush, and ginek., No. 6, page 95, 1964; Ott D. O. Operation of formation of an artificial vagina at its inborn absence, and also at the acquired its fusion after a gangrenous colpitis, in the same place, No. 2, page 146, 1929; P e r-sianinovl. C. Operational gynecology, page 418, M., 1976; D. D. Priests. Operation of formation of an artificial vagina from a rectum, SPb., 1910; Snegirev V. F. New way of formation of an artificial vagina, M., 1892; Sherstnev B. F. Anemic method of a colpopoiesis, Akush, and ginek., No. 11, page 42, 1967; Baldwin J. F. The Baldwin operation for the formation of an artificial vagina, Surg. Gynec. Obstet., v. 45, p. 569, 1927; David A. o. Congenital absence of the vagina, Obstet, and Gynec., v. 46, p. 407, 1975; F o r e S. R. a. o. Uro-logie and genital anomalies in patients with congenital absence of the vagina, ibid., p. 410; Friedberg V. Die Bildung ei-ner kiinstlichen Vagina mittels Peritoneum, Geburtsh. u. Frauenheilk., Bd 34, S. 719, 1974; Rochet Y. et Gagnaire J. C. Les aplasies du vagin, J. Gynec. Obstet. (Paris), t. 3, p. 223, 1974.
H. D. Seleznyova.