Which of the following surgeries involves a transverse anterior colpotomy, dissection of the bladder up to the internal cervical os and a posterior colpotomy with dissection of the areolar tissue and peritoneum upwards to the internal os?

1. A

   Shirodkar operation

2. B

   River operation

3. C

   Michaelis plan operation

4. D

   Stoppa's operation

Appeared in: DSSSB October 2024

Explanation

• The Shirodkar operation is a surgical procedure used to treat cervical insufficiency by placing a suture high around the cervix.
• The question describes the key steps of this procedure, including a transverse anterior colpotomy (incision in the vaginal wall) and dissection of the bladder to access the cervix at the level of the internal os.
• This technique is more invasive than the simpler McDonald cerclage, which does not involve such extensive dissection.
• The goal is to provide structural support to the cervix to prevent it from dilating prematurely during pregnancy.

Why Other Options Were Wrong

• Option B: This is not a recognized standard surgical procedure in gynecology or obstetrics.
• Option C: The Michaelis rhomboid is an anatomical landmark of the pelvis used to assess the pelvic outlet during labor, not a surgical procedure.
• Option D: Stoppa's operation is a well-known procedure in general surgery for the repair of large inguinal hernias.

Related Visual

Clinical Relevance

• Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Surgical management of cervical insufficiency as background academic context rather than a clinical decision trigger.
• Nurses must be aware of the different cerclage types to provide appropriate post-operative care, including monitoring for signs of infection, preterm labor, or premature rupture of membranes.
• Understanding the invasiveness of the Shirodkar procedure helps the nurse anticipate potential complications like increased bleeding, bladder irritation, or difficulty with suture removal.
• Patient education is crucial. The nurse must explain activity restrictions, signs of complications to report, and the plan for suture removal, which often requires anesthesia for a Shirodkar cerclage.

How to Approach the Question

• This is a factual recall question testing knowledge of specific surgical procedures.
• First, identify the key surgical steps described in the stem: transverse anterior colpotomy, bladder dissection, and dissection up to the internal os.
• Recognize that these detailed, invasive steps point towards a complex procedure to access and suture the cervix at a very high level.
• Evaluate the options provided. The Shirodkar operation is a known type of cervical cerclage.
• Systematically eliminate the distractors. Stoppa's operation is for hernia repair. The Michaelis rhomboid is an anatomical landmark, not a surgery. 'River operation' is not a standard medical term.
• Conclude that the described steps precisely match the Shirodkar procedure, which is distinguished from other cerclages by its invasive nature and high placement of the suture.

Concept Tested & Keywords

• Concept Tested: Surgical management of cervical insufficiency
• Stem keywords: transverse anterior colpotomy, dissection of the bladder, internal cervical os, posterior colpotomy
• Lead-in keywords: Which of the following surgeries

Question ID

QVzMtmYdJ1U9PaTamx3wU_

Copy ID

Reference Book

E6 Obstetrics Williams p. 4-11