Transabdominal Cervical Cerclage: Laparoscopy Versus Laparotomy

J Minim Invasive Gynecol. 2015 Sep-Oct;22(6):968-73. doi: 10.1016/j.jmig.2015.04.019. Epub 2015 Apr 28.

Abstract

Study objective: To evaluate the obstetric outcome, surgical morbidity, and pre-abdominal cerclage characteristics of women undergoing transabdominal cerclage (TAC) via laparotomy or laparoscopy.

Design: Prospective cohort study (Canadian Task Force classification II-2).

Setting: University hospital.

Patients and intervention: Between 2007 and 2014, 51 patients underwent laparoscopic abdominal cervical cerclage to treat cervical incompetence. These women were compared with a historical cohort of 18 patients who underwent the same procedure via laparotomy between 1995 and 2011. All of the women had a diagnosis of cervical incompetence based on previous obstetric history and/or a short or absent cervix.

Measurements and main results: The fetal survival rate postcerclage was 100% in the laparotomy group (n = 30 pregnancies) and 98% in the laparoscopy group (n = 54 pregnancies). There were no perioperative pregnancy losses in either group. The median gestation age was 36.9 weeks (range: 35.0-37.3) in the laparotomy group and 37.0 weeks (range: 34.7-38.0) in the laparoscopy group. Complications were recorded in 4 (22%) cases from the laparotomy group and 1 (2%) of the laparoscopies; however, the types of complications might not be comparable between groups. There were no conversions to laparotomy in the laparoscopy group. Pre-TAC median gestational age in the laparotomy group was 24.0 weeks (range: 20.0-25.1) with 19 (57.6%) previous pregnancies occurring after transvaginal cervical cerclage placement. The corresponding laparoscopy pre-TAC median gestational age was 22.0 weeks (range 19.0-34.0) with 40 (40%) previous pregnancies having a transvaginal cerclage. Before the TAC, women in the laparotomy group had lost 25 babies, and 63 babies were lost in the laparoscopy group. After TAC, these numbers were 0 and 1.

Conclusions: Our findings show that transabdominal cervical cerclage placed laparoscopically appears to be as effective as TAC placed via laparotomy. Neither approach was associated with serious or long-term complications. Because of this finding, the approach depends on the surgical experience and expertise of the unit in conjunction with discussion with the patient.

Keywords: Abdominal cerclage; Cervical incompetence; Laparoscopy; Laparotomy.

Publication types

  • Comparative Study
  • Evaluation Study

MeSH terms

  • Abdomen / surgery*
  • Adult
  • Cerclage, Cervical / methods*
  • Female
  • Humans
  • Laparoscopy / methods*
  • Laparotomy / methods*
  • Pregnancy
  • Prospective Studies
  • Treatment Outcome
  • Uterine Cervical Incompetence / surgery*