This is the first of its kind approach for surgical management of genital prolapse in reproductive age women. Pelvic organ prolapse (POP) is defined by ICS as the descent of one or more of the anterior vaginal wall, posterior vaginal wall, the uterus, or the apex of the vagina (vaginal vault after hysterectomy) (1). POP causes significant discomfort and greatly affects the quality of life, activities of daily living, sexual activity and exercise and has a negative impact on a woman’s body image. According to existing studies, the reported prevalence of POP varies widely, ranging from 3 to 50%. In India, nulliparous prolapse constitutes 1.5 to 2% of prolapse. The incidence is even higher (5–8%) for young women who have delivered one or two children, thus making it one of the highest rates in the world (2). In women with nulliparous prolapse, there usually is a component of cervical elongation without associated anterior (cystocele) or posterior (rectocele) compartment prolapse.
There are a variety of surgical management options, both conservative and extirpative for repair of pelvic organ prolapse (POP). Surgical treatment for POP includes native tissue repair, augmentation with mesh, and minimally invasive surgeries by laparoscopy and robotics; each one with its own advantages and disadvantages.
Among the various sling surgeries described for treatment of nulliparous prolapse, one was described by Purandare in 1965 (3). He created sling from strips of rectus sheath and anchored it anteriorly at the level of isthmus of uterus. The advantages of Purandare sling are it is technically easy to perform and provides dynamic support to the uterus. The disadvantages are, the uterus becomes retroverted and there is a tendency of enterocele formation. Also, as the sling is anchored anteriorly, it maybe damaged at subsequent caesarean sections. To overcome these shortcomings, we introduced a novel technique, in which the strips of rectus sheath are created 1.5 cm wide and 8 cm long on both sides of midline, stay sutures are taken from the medial free ends of the strips with No. 1 Prolene suture. The strips are then brought into the peritoneal cavity just lateral to the rectus muscle and then to the posterior surface of uterus through an avascular area in broad ligament, passed under the visceral peritoneum of posterior surface of uterus on both the sides from lateral to medial and brought out in midline. The stay Prolene sutures on both sides are tied to each other and the strips of rectus sheath are anchored to the posterior surface of uterus at the mid point at the level of isthmus, just above the uterosacral ligaments. The overlying visceral peritoneum of uterus is closed.
In literature, there have been reports on usage of mersilene tape and attaching it posteriorly to the uterus. But, this technique of anchoring the strips of rectus sheath posteriorly to the uterus has not been described in literature previously.
The aims of this study are to evaluate the role of novel technique using autologous rectus sheath for treatment of genital prolapse in reproductive age women and to study the operative time, blood loss and intraoperative and post operative complications if any.