From Big Medical Encyclopedia

COLPORRHAPHY (colporrhaphia; Greek kolpos a female bosom, a vagina + rhaphe a seam) — plastic surgery of removal of excess fabric from walls of a vagina and sewing together of the fascia located under them.

Distinguish front, median and back To. Features of the equipment back To. — see. Colpoperineoplasty . A lobby To. it is usually combined with sewing up of a fascia over a bladder, and back To. — with plastics of muscles of a pelvic bottom. Both look To. items are made at omission and loss of walls of a vagina, at bruises of a vagina and crotch (in labor, during the falling etc.). Median To., Persianinova who is carried out also in modification (see. Lefora — Neygebauera operation ), it is applied at women of senile age. In the presence of diseases of a neck of uterus and vagina median To. it is contraindicated.

Diagrammatic representation of operation of a front colporrhaphy: 1 — from a front wall of a vagina otseparovan an oval rag; 2 — separating of side edges of a vulval wound from the subject fascia; 3 — the end of sewing up of a vaginovesical fascia; 4 — suture on a vulval wound.

Lobby To. it is made in position of the patient, usual for vulval operations, under a local infiltration anesthesia. For? the best separating of fabrics it is reasonable to infiltrirovat a wall of a vagina solution of novocaine. After processing of external genitals alcohol and iodine the neck of uterus is bared by means of mirrors, the front lip of a neck is taken nippers and reduced to an entrance to a vagina. After that on a naked front wall of a vagina the scalpel plans the oval rag assumed to removal: the upper corner of a rag shall be at distance of 1,5 — 2 cm from an outside opening of an urethra, lower — at the level of the front vulval arch. Width of a rag depends on degree of prolixity of a vulval wall and expressiveness to a tsistotsela (see): the more the wall of a vagina is stretched, the more widely there has to be a rag. Then do the section getting to a loose coating of cellulose over a fascia between a wall of a vagina and a bladder. The section is done not really deep in view of danger of wound of a bladder. Separating is usually begun with an upper corner acute and partly with a stupid way a scalpel and small gauze tupfer (fig., 1). After removal of a rag carefully stop bleeding. If omission of walls of a vagina is combined with the tsistotsel, after removal of a rag it is necessary to separate in sides of edge of a vulval wound throughout (fig., 2) on width of 1 — 1,5 cm for their best rapprochement. Then an acute and stupid way separate a bladder from a neck of uterus. On legs of the fascia going from a bubble to a neck of uterus noose catgut sutures are put. The naked vulval fascia over a bladder, since an upper corner of a wound, is sewn up for reduction of protrusion of a bladder and creation for it an additional support in the form of reinforced fascial fabric with one of ways: continuous catgut suture (fig., 3), separate knotty catgut seams or purse-string seam. After mending of a fascia of edge of a vulval wound connect catgut seams (fig., 4). Enter tampons with a liquid paraffin into a vagina.

If there is no independent urination within 2 — 3 days, catheterization of a bladder 2 times a day is made. For the best healing of a postoperative wound it is reasonable to detain a chair during 3 days.

Bibliography: Makarov R. R. and Gavelov A. A. Operational gynecology, L., 1977; The Multivolume guide to obstetrics and gynecology, under the editorship of L. S. Persianinov, t. 6, book 2, page 442, M., 1961; Persianinov L. S. Operational gynecology, M., 1976, bibliogr.

I. M. Gryaznova.