Background: The objective of the current study was to assess the need of vault suspension after completion of hysterectomy in all cases of procedentia to prevent vault prolapse and to reduce the operating time for sacrocolpopexy using combined vaginal and laparoscopic approach by two surgeons.Methods: A total of 25 women undergoing surgery for procedentia were included. After completion of hysterectomy the need for vault suspension was assessed intraoperatively. In all cases polypropelene mesh was fixed vaginally to the uterosacral and cardinal ligaments. Vaginal vault was closed vaginally. Laparoscopic surgeon did laparoscopic sacrocolpopexy (LSC). Intraoperative and post-operative complications were then evaluated.Results: Our average operating time was 35 minutes for vaginal hysterectomy and 15 minutes for LSC. The shorter duration of surgery was because mesh was fixed vaginally and trackers were used to fix the mesh to sacral promontory. Intraoperative complications like bladder, ureteric, bowel injuries and hemorrhage were nil in our series. Postoperative stay in hospital was uneventful and all cases were discharged on second postoperative day. Conversion rate to laparotomy was nil. All cases have completed follow up for 5 years with 100% subjective and objective improvement.Conclusions: Restoration of vagina to its normal anatomic position remains the most important fact to prevent vault prolapse. Our technique is very easy, less time taking with negligible complication rates.

Background: During laparoscopic ventral hernia repair (LVHR) mesh is used and so this procedure is not combined with any other major surgery, due to the risk of mesh infection. We did laparoscopic hysterectomy (LH) with LVHR in our study group and found it to be safe procedure with excellent patient recovery and satisfaction rates. Aims and objectives of the study was to assess the short- and long-term clinical outcomes of doing LH and LVHR simultaneously. The primary objectives were to evaluate the intraoperative and post-operative complications, mesh infection rates, hernia recurrence rates and patient satisfaction rates for at least 4 years.Methods: This prospective study was conducted at Aarogya Hospital and test tube centre from 1st January 2007 to 31st December 2016 and follow up completed by 31st December 2020. Total 100 women were included, willing for LH and LVHR simultaneously irrespective of the size of uterus and hernia defect size up to 7cms.Results: Maximum number of patients 65% were in the age group of 45-55 years. 70% patients had previous surgeries commonest being LSCS in 46% cases. Hernia defect size was between 3-5 cm in length and width in 70% cases, requiring dual mesh fixation in 68% cases of size 15x15cms. Our recurrence rate for hernia was nil, 98% cases were highly satisfied with the surgical outcomes by the end of 4 years follow-up.Conclusions: We emphasize that LH can be easily done with LVHR in combination reducing operative morbidity.

Uterine torsion (UT) is defines as a rotation of the uterus of more than 45 degree on its long axis. The predisposing factors for UT can be uterine asymmetry due to fibroids or mullerian anomalies, foetal malpresentation, pelvic adhesions and abdominal or ligamentous laxity other possible causes include external cephalic version, maternal trauma and abdominal massage. The clinical presentation of UT is non-specific. We report a case of previous 2 CS where we suspected rupture uterus but intraoperatively it was UT with unruptured fibrosed scar of previous CS. A 31 years old, G3P2 presented in emergency department with history of amenorrhea 9 months and severe abdominal pain for 5-6 hours. She had previous 2 CS done for contracted pelvis. We immediately suspected rupture of previous CS scar. On laparotomy dense intra-abdominal adhesions were found. After adhesiolysis we could find any sign of previous scar on the visible uterine wall. Entire uterine wall seemed as if we were doing CS in a primiparous patient. This made us suspicious of UT. UT is considered rare and has been referred to as an ‘obstetrician’s once in a lifetime diagnosis’. Recently cases have been reported with no associated pelvic factors although a common feature in all these cases had been previous CS. UT is a potentially dangerous complication of pregnancy both to the mother and to the foetus. Maternal mortality in modern era highly unexpected event but maternal morbidity can occur because of complications like uterine rupture, uterine abruptio, sepsis, pulmonary embolism and iatrogenic complications like injury to blood vessels, urinary tract and rectum. During laparotomy where correction of UT is not possible, a deliberate posterior hysterotomy can be done for delivery of foetus. Bilateral plication of the round ligaments can be done to prevent immediate postpartum recurrence of UT. UT though rare should be kept in mind while performing CS in cases of previous CS, associated myomas, ovarian tumour, malpresentations of foetus. Clinical symptoms may be absent or nonspecific and the diagnosis may be intraoperative.

Background: To standardize our protocol of caesarean myomectomy to make it safe and feasible for all patients.Methods: This prospective study was conducted in Aarogya Hospital and test tube baby Centre, Raipur from 1st January 2008 to 1st August 2020. Total 45 patients who had documented fibroid in index pregnancy and consented for the procedure were included. B- Lynch sutures were prophylactically applied in all cases to prevent PPH.Results: Our maximum patients were between the age of 20-30 years (66.67%) and 75.56% were primigravida. 44.45% cases were of intramural fibroids and in 53.34% cases the size of myoma was >5 cm. Malpresentation was seen in 15.56% cases. 62.22% myomas were removed through single incision. 33.33% patients had uneventful second CS with us with excellent scar healing in 93.33% cases. 20% cases had secondary infertility and are advised further evaluation to find cause of infertility.Conclusions: The decision to proceed with elective myomectomy at time of CS should be approached with proper pre-operative evaluation of the patient, thorough counseling for hysterectomy if required, expert team, arrangement of blood and adequate correction of medical factors like anemia, hypertension, and diabetes mellitus. Prophylactic application of B -Lynch sutures in all the cases made a dramatic improvement in tone of uterus which we observed intra operatively.

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