Shirodkar sling surgery

Shirodkar sling surgery with videos of every step

1. SHIRODKAR’s SLING SURGERY

2. DR. NIRANJAN CHAVAN MD, FCPS, DGO, MICOG, DICOG, FICOG, DFP, DIPLOMA IN ENDOSCOPY (USA) Professor and Unit Chief, L.T.M.M.C & L.T.M.G.H, Sion Hospital Joint Treasurer Elect, FOGSI (2021-2024) Member Oncology Committee, SAFOG (2020 onwards) National Co-Ordinator, FOGSI Medical Disorders in Pregnancy Committee (2019-2021) Vice President MOGS (2020-2021) Scientific Secretary, AFG (2020-2021) Chair & Convener, FOGSI Cell Violence Against Doctors (2015-16) Dean & Chief Content Director, HIGHGRAD E3 Courses Chairperson, FOGSI Oncology and TT Committee (2012-2014) Course Co-Ordinator of 11 batches of MUHS recognized Certificate Course of B.I.M.I.E at L.T.M.G.H (2010-16) Member, Oncology Committee AOFOG (2013-2015) Member, Managing Committee IAGE (2013-17), (2018-20) Editorial Board, European Journal of Gynaec. Oncology (Italy) Course Co-Ordinator of 3 batches of Advanced Minimal Access Gynaec Surgery (AMAS) at LTMGH (2018-19)

3. DR V. N. SHIRODKAR (1899-1971) Vithal Nagesh Shirodkar was born in 1899 in the village of Shiroda in Goa from which his family derived its name. He was educated in Hubli and completed his medical training at the Grant Medical College in Bombay. He passed the final MBBS exam in 1923. He specialized in Obstetrics and Gynecology and received the MD from the University of Bombay in 1927.

4. There after he proceeded to England for higher studies. The exposure to the West helped him immensely. Here he imbibed the latest surgical procedures and met many eminent doctors and scientists. He obtained the FRCS (England) in 1931 and was appointed Honorary Professor of Obstetrics and Gynecology to the J.J. Group of Hospitals in Bombay Besides being a busy practitioner Professor V. N. Shirodkar published widely and took a keen interest in social medicine. He was a member of the Shantilal Shah Committee on abortions and also established the Family Planning Association in India. In 1971, the Government of India honored him with the Padma Vibhushan award.

5. CONTRIBUTIONS TO Obstetrics and gynaecology Shirodkar’s Cervical Cerclage

6. Multiple instruments for surgery

7. Shirodkar’s sling surgery

8. I n India, nulliparous prolapse cases constitute 1.5–2 % of genital prolapse ; the incidence is even higher (5–8 %) for young women who have just delivered one or two children making it one of the highest in the world . The prevalence is very high in India because Indian women, especially those with poor socioeconomic status, are anemic and malnourished (‘ maternal depletion syndrome ’) with poorly developed pelvic floor tissues and the additional insult of one or more vaginal deliveries at home is sure to bring down the cervix and uterus. Thus, in the evolution of conservative operations for prolapse, many sling operations were described in India that soon became very popular because of their simplicity and effectiveness.

9. The various conservative sling operations for genital prolapse in young women who want to preserve fertility are: Shirodkar sling: 1960 Purandare cervicopexy: 1965 Khanna sling: 1972 Sonawala sling: 1978 Joshi sling: 1993 Virkud's sling: 1999

10. CLASSIFICATION OF SLING SURGERY According to position of support Anterior – The support comes from anterior part of pelvis or abdomen. Example- Purandare’s sling, Joshi’s sling. Posterior - The support comes from posterior part of pelvis or abdomen. Example – Shirodkar’s sling, Sonawala sling.

11. According to dynamics of support Static Sling – In this, support is static like the sacral promontory/anterior superior iliac spine. Example- Shirodkar’s sling, Khanna’s sling, Sonawala’s sling, Joshi’s sling. Dynamic Sling – In this, support is dynamic like the anterior abdominal wall (comes into action only when required). Example – Purandare’s sling.

12. Type of loop closure Closed loop sling – The loop is closed from both sides. One disadvantage is that if the loop is very narrow, it may cause bowel obstruction . Example- Shirodkar’s sling, Purandare's sling, Joshi’s sling. Open loop sling – The loop is open from one end. Example – Khanna’s sling, Virkud’s sling, Sonawala’s sling.

13. SELECTION CRITERIA FOR SLING OPERATION In order to decide which patient is suitable for a sling operation, certain selection criteria for must be followed. These are: Young women with second or third-degree uterocervical prolapse. Uterocervical length of less than five inches. Absent or minimal cysto/rectocele. If moderate to large cysto/rectocele is present, it should be repaired from below at the same sitting before performing the sling. CI in hypertrophied, lacerated and infected cervix.

14. A case of 35 years old multiparous with complain of something coming out of vagina since 1 year wanting conservative surgery. We did Shirodkar’s Sling Surgery.

15. Step 1 Abdomen is opened at the level of Anterior Illiac Spine till visualization of Uterus.

16. STEP 2 Uterus held with a Shirodkar’s uterus holding forceps. Mersiline tape is fixed to posterior part of cervix . On left side, retroperitoneum is opened and mersiline tape is passed through psoas muscle thus making a psoas loop .

17. STEP 3 With help of Shirodkar’s needle mersiline tape is passed through broad ligament and through the psoas loop of left side. Then an avascular window is made within the sigmoid mesocolon and merciline tape is passed through it.

18. STEP 4 Similarly, on right side, with help of Shirodkar’s needle, mersiline tape is passed through right leaf of broad ligament .

19. STEP 5 Both sides of Mersiline tape are now held together and sutured to the anterior longitudinal ligament of sacral promontory.

20. STEP 6 Since it is a closed loop sling surgery, if the sling is too narrow it may cause bowel entrapment. To prevent this, three finger space should be left between the uterus and the retroperitoneum. The mobility of the uterus is also checked.

21. The abdomen is closed in layers.