Genital prolapse is one of the major complaints encountered in our gynaecological practice. Various conservative and operative modes of treatment have been devised to cure the condition. No subject has evoked more discussion, debates, and disagreements in Gynaecology as that of conservative management of prolapse in patients who are interested in retaining fertility and childbearing.

Today most gynecologists are employing Fothergill-Manchester operation or abdominal sling operation to correct prolapse uterus in young women. n. In Fothergill-Manchester Repair, amputation of the cervix, the advancement of Mackenrodt’s ligaments to the anterior aspect of what remains of the cervix, an anterior colporrhaphy, and perineorhhapy are done.

This time- honoured technique has various shortcomings i.e. cervical stenosis, infertility, cervical incompetence, cervical dystocia during labor, dyspareunia, and recurrence of prolapse after pregnancy or otherwise was also reported to the extent of 20-25% (Shaw 1933). An ideal conservative method should preserve menstruation, restore fertility, and should not interfere with labor and of course be technically easy at the same time [1-5].

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 described a technique for the surgical treatment of genital prolapse in young women in 1965 [6].

In gynecology, Dr. Shirodkar’s contribution to uterocervical prolapse is a matter of pride for us, the Indians. Conservative surgery that is Shirodkar’s abdominal sling operation is the perfect and complete anatomical solution to weak uterosacral ligaments. It restores the anatomy of the uterus repairs the descent as well as cystocele and enterocoele. Of course, it is a bit difficult and bold procedure, results are excellent.

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

This loop is made to prevent kinking of sigmoid colone.

After this peritoneum on the posterior surface of the uterus near the isthmus is incised. One long curved artery forceps is passed extraperitoneal along the right uterosacral ligament to catch the right end of the mercelene tap. This right end comes out through this incision on the posterior surface of the uterus. The same way the left end of the mercelene tap is caught along the left uterosacral ligament via psoas loop. Both the ends of the mercelene tap are fixed on the posterior part of the uterus so as the uterus is pulled up and remains anteverted. Externalos comes at the ischial spine level. Excess tap is exiced.

Peritoneum over the posterior surface of the uterus over the left psoas and in front of the sacral promontory is repaired. Abdominal cavity cleansed and abdomen is closed in layers. Rectus is repaired in double breasting to prevent incisional hernia. Prophylactic antibiotics and anti-inflammatory drugs were prescribed for seven days. Postoperative management as usual as in any major surgery.

Stitches were removed on the eighth-day women were discharged on a ninth day. Follow up was recorded after one month. After the 33^rd 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.

Table-1: Age-wise Distribution of study participants.

The majority of women are of age 21 to 30 years I e 26 women

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.

A _case no 2 had developed incisional hernia after one year. Hernioplasty was done.

From this case, it was a learned lesson to repair the rectus sheath with extra care I e double breasting. Whenever possible, transverse incision was used, in that exposure to promontory was a little difficult. Same case no 2 came after 8 years for urinary infection.

B _Three women came for an antenatal check-up and all were delivered vaginally.

Sling was intact in all cases on follow up.