Study of Abdominal Shirodkar sling operation for uterocervical prolapse

Study of Abdominal Shirodkar sling operation for uterocervical prolapse M Patel U.1*, B. Shah M.2, R. Shah J.3 DOI: https://doi.org/10.17511/joog.2020.i06.03 1* Uday M Patel, Associate Professor, Department of Obstetrics and Gynaecology, GMERS Medical College, Patan, Gujarat, India. 2 Manoranjana B. Shah, Retired Professor, Department of Obstetrics and Gynecology, B J Medical College, Ahmedabad, Gujarat, India. 3 Jui R. Shah, MBBS, B J Medical College, Ahmedabad, Gujarat, India.


Introduction
Genital prolapse is one of the major complaints encountered in our gynaecological practice. Various As this type of prolapse occurs at a younger age, the surgical technique should not only reduce the prolapse but also retain the reproductive function.
Various conservative surgeries have been described in the past, each having its own merits and demerits. Purandare

Aim of the study
To study the procedures of abdominal Shirodkar sling itself and its results.

Study setting
Women who attended the gynecology Department of the Civil hospital of Ahmedabad with complaints of uterine prolapse were selected.

Inclusion criteria
Obese women, women having uterine pathology, and cervical pathology were not included in the study.

Ethical approval
Ethical approval was taken from the institutional ethical committee and written informed consent was taken from all the participants.

Data collection
Women were examined and were submitted to all investigations for major surgery. Performa included name, age, detail address, parity, menstrual history, local examination, P/V, P/S, and investigations. Stitches were removed on the eighth-day women were discharged on a ninth day. Follow up was recorded after one month. After the 33rd case was operated on, all women were called for follow-up by writing the letter. Many women came; their story is included as long term follow up.

Statistical analysis
The recorded data was compiled and entered in a spreadsheet computer program (Microsoft Excel 2007) and then exported to the data editor page of SPSS version 15 (SPSS Inc., Chicago, Illinois, USA). For all tests, confidence level and level of significance were set at 95% and 5% respectively. The majority of women are of age 21 to 30 years I e 26 women 18 women are para two and three. Two nulliparous had congenital prolapse of 3rd degree. Next in the evolution of conservative surgery for prolapse many sling surgeries were described which soon became popular because of their simplicity and effectiveness.

Patel UM. et al: Study of Abdominal Shirodkar sling operation
In two cases psoas loop was fixed on the right psoas muscle as the mesentery was on the right side.
In two cases there was lumborization of Sacrum. It was confirmed on the x-ray.
Dissection at sacral promontory was difficult.
In one case prolene mash was used due to the non-availability of osmercelene tap. It worked well.
One woman had a unicornuate uterus with rudimentary horn and the left ovary had lemon size cust, so along with sling cystectomy was performed.
Obs Gyne Review -Journal of Obstetric and Gynecology 2020;6(6) Initially, native fascia like fascia lata and rectus sheath was used which later got replaced by synthetic slings that produce minimal tissue reaction and remain unabsorbed giving lifelong support [11].

Failure of conservative surgeries like traditional
Fothergill's or sling surgeries was because of the use of native fascia for repair, the same endopelvic fascia that has caused prolapse. The use of synthetic materials like merselene tape and mesh in modern sling surgeries has decreased the failure rates and gives lifelong support.
Out of thirty-three selected women, two cases could not be operated. In one case, the Anterior longitudinal ligament could not be dissected due to big vessels in front of the promontory, in that case, an anterior purandare sling was performed. In the second case while dissecting at sacral promontory profuse bleeding occurred so the procedure was postponed.

Post-Operative Period
Thirty women had an uneventful postoperative period. They were discharged on the 8th or 9th day.
One woman developed pain in the left iliac fossa on the third day, she was switched over higher antibiotic and anti-inflammatory and became alright. One woman had deep gaping on stitch removal which was resutured. One woman was operated on 25th January, on 26th there was a high scale earthquake in Ahmedabad she had run to the ground floor with IV line and bottle in her hand.
Fortunately, her stitches were fine and she was discharged on the 8th day. All women reported after one month as per our advice all were fine.

Long Term Follow Up
Eight women reported after a long time for the following purposes.

Conclusion
Abdominal sling with Dr. Shirodkar's method is the real corrective solution to weekend uterosacral ligaments. It is the perfect anatomical solution for a conservative approach to uterocervical descent. Ofcourse Procedure is difficult and requires boldness.
What does the study add to the existing knowledge?