The Shirodkar cerclage is a form of transvaginal cerclage performed to address cervical deficiencies. Though similar to McDonald cerclage, the Shirodkar technique entails passing the sutures via the cervical walls to keep them unexposed. During the procedure, the surgeon pulls up the cervix using forceps while pushing the vaginal walls back. Minor incisions are done at a spot where the vaginal tissue interacts with the cervix. Later, a needle and tape are put through the incisions to tie the cervix shut.
The technique was first demoed by a renowned Indian gynecologist and obstetrician, Dr. Vithal Nagesh Shirodkar, in 1955. Dr. Shirodkar used an absorbable suture material, which was later replaced by Mersilene tape – a polyester fiber-made non-absorbable suture. The Shirodkar technique is also recommended to patients who’ve had a failed McDonald cerclage or have cervix structural abnormalities.
Pros and Cons
With the Shirodkar technique, the sutures could be positioned high enough on the cervix to ensure there is little to zero damage to the rectum or bladder.
Compared to the McDonald cerclage, this procedure is noticeably harder to execute – especially on obese women. The procedure is often time-consuming, with increased infection and hemorrhage risks.