Review of Uterine Sling after Five Years of Operation in a 40 Years Lady.

Uterine sling is a operation, done with own rectus sleeve to correct the uterine descend. If necessary correction of cystocele and/or rectocele and or perineal tear done on the same sitting. After 5 years of such operation abdomen of Mrs. X was opened due to ovarian cyst in Nirapad Hospital, Shantinagar, Dhaka, Bangladesh on August 2016. Uterus was found in normal position and size. Rectus sleeves were found attached with the uterus where it was anchored. Omentum was attached over the rectus sleeves and sealed the weak points at both lateral ends of the rectus sleeves through which the sleeves were taken to the abdominal cavity. Omentum was also attached to the posterior leaf of the broad ligaments where the sleeves were sutured to minimize the dead spaces. During this 5 years period the patient felt no discomfort or pain due to the sling or experiences any further descend of the uterus.

A friendly approach to repair fourth degree perineal tears.

This observational study was done to make the Gynecologists familiar with the procedure of continuous repair of rectal mucosa and repair of the anal sphincter by other than figure of 8 sutures and to assess the effectiveness of the procedure. This study was carried out in two teaching hospitals and other two private hospitals in Dhaka city and out side. Total 20 patients were included in this study. All had fourth degree perineal tear and were repaired with the new approach. Follow up was carried out at 6th week, 12th week, and 24th weeks. Among 20 patients a large number of women were mother of one child and were of 21-25 years age group. At post operative period - wound infection was nil. Perineums were well established in all cases. On follow up at 24th week - pain in perineum and dyspareunia was nil in all cases, though this was present at early weeks in few cases. Faecal incontinence was absent in all patients by 24 weeks postoperatively. In follow up visits there was no complaint of faecal incontinence. In few cases pain was present in early post operative periods but dyspareunia was absent. So, continuous repair of anal mucosa and repair of anal sphincters other than figure of eight seems better regarding technical easiness, better compliance for the surgeon and less traumatic to the rectal mucosa and ultimately better results.