LESSON 2: Procedures in Gynecological and Obstetrical Surgery

Section Ii: vaginal surgery

2-26

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2-26. SHIRODKAR OPERATION (POSTCONCEPTIONAL)

a. General. This operation involves the placement of a collar-type ligature or other material at the level of the internal os to close it. It is made necessary by incompetence of the cervix, a condition characterized by habitual midtrimester spontaneous abortions. The operation is designed to prevent the cervical dilatation that results in release of uterine contents.

Figure 2-7. Principles of Shirodkar operation for treatment of

incompetent internal cervical os during pregnancy.

b. Operative Procedure (see figure 2-7).

(1) Anterior and posterior vaginal retractors are placed, and the cervix is pulled down with smooth ovum or sponge forceps. With thumb forceps and dissecting scissors, the mucosa over the anterior cervix is opened to permit the bladder to be pushed back.

 

(2) The cervix is lifted, and the posterior vaginal mucosa is similarly incised at the level of the peritoneal reflection. With ligature carriers, the lateral mucosa is tunneled on either side.

 

(3) The prepared ligature is placed at the desired level and anchored posteriorly with silk suture, then drawn tight in front to close the cervix. The suture is tied.

 

(4) The collar ligature is anchored with silk sutures anteriorly. The anterior and posterior mucosal incisions are closed with chromic sutures number 0 or number 2-0 to complete the procedure.

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