SIGNIFICANCE OF LAYERED STRUCTURE OF PUBIC REGION OF ANTERIOR ABDOMINAL WALL IN SUPRAVESICAL EXTRAPERITONEAL CAESAREAN SECTION TECHNIQUE G. L. DRANDROV’S TYPE

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Aim. To study the topographo-anatomic peculiarities of pubic region of anterior abdominal wall for providing an adequate supravesical extraperitoneal approach to a lower uterus segment. Material and Methods. Research was performed using both cadaveric and biopsy material, which is collected during supravesical extraperitoneal caesarean section by G. L.Drandrov’s technique. The following methods were used: dissection, intraoperational observation, microscopy of sections, stained with hematoxylin and eosin. Results and Discussion. Deep layers of anterior abdominal wall in a pubic region are presented by transverse, prevesical, retrovesical fasciae and peritoneum. While dissection of cadaveric material it was revealed, that layers of prevesical and retrovesical fasciae, covering urinary bladder from anterior and posterior sides, adjoin transverse fascia laterally. Urachus is situated along the midline of the abdomen between prevesical and retrovesical fasciae. There is a proper prevesical fascial space, which is situated between transverse and prevesical fasciae; and space around urinary bladder between prevesical and retrovesical fasciae is perivesical fascial space. Purulent processes and haematomas can migrate along the ureters to pararenal fat. Retrovesical fascial space is located behind retrovesical fascia. Pathologic contents of this space can propagate to retroperitoneal cellular space. These observations allow us to suppose an uninterrupted transition of pre- and retrovesical fasciae into anterior and posterior layers of renal fascia correspondingly. Conclusions. The main indication for an extra-peritoneal caesarean section is a high risk of infection. Safety and absence of complications at such surgeries depend upon a technique of their performance in consideration with topographic anatomy of anterior abdominal wall. Knowing an existence and path of prevesical and retrovesical fasciae will help doctors to perform surgical interventions for pelvic organs with less traumaticity and define the most probable pathways of pus and haematomas propagation at a postoperational period in case of complications.