Laparoscopic Transabdominal Cerclage

Abstract

<p> <span>Cervical insufficiency is seen in 0.1%</span><span> </span><span>-</span><span> </span><span>1% of all pregnancies and classical treatment involves vaginal cerclage. In some conditions, such as an extremely short, deformed or absent cervix, surgery needs to be done by transabdominal ap</span><span>proach.</span><span> </span><span>We use a simplified technique for laparoscopic transabdominal cerclage compared to the technique described in previous studies. Furthermore</span><span>,</span><span> we give a review on the literature published on this subject. We have a case series of 12 patients operated in a non-pregnant state with previously failed vaginal cerclage (n</span><span> </span><span>=</span><span> </span><span>4) or in wh</span><span>ich</span><span> a vaginal approach appeared to be impossible due to a history of cervical surgery (n</span><span> </span><span>=</span><span> </span><span>8). Minor complication of vaginal erosion of the cer</span><span>clage tape was described in 2 cases.</span><span> </span><span>Comparable studies of transabdominal cerclage via laparotomy or laparoscopy could not show any difference in obstetric outcome. Several studies mention</span><span>ed</span><span> the advantages of the laparoscopic ap</span><span>proach (short hospitalisation, fast recovery, high placement of the suture</span><span>,</span><span><span></span><span>) and no complications were described.</span><span> </span><span>Transabdominal cerclage performed by laparoscopy seems to be a feasible technique in cases</span><span> </span><span>transvaginal cerclage fails or </span><span>is</span><span> technically impossible.</span></span> </p

Transabdominal Cervical Cerclage: Laparoscopy or Laparotomy

“…Aside from the more complexity in the procedure of a TAC, there are some points of interest when utilizing this method rather than the transvaginal cerclage, i.e., high situation of the suture, no slippage of the cerclage, absence of the suture material inside the vagina that could bring about infection and preterm labor, and the advantage to leave the tape in situ between pregnancies. 3 To utilize this method laparoscopically, the surgeon needs ability in laparoscopic suturing. In contrast with laparotomy, laparoscopy outcomes are less or no hospitalization, less postoperative torment, and quicker recovery.…”

“…As with the open transabdominal approach, cesarean section is necessary to deliver the baby. [1][2][3] The transabdominal cervical cerclage can be done as a prophylactic procedure or as an indicated one. The specific indications include those people in whom an agreeable transvaginal cerclage is not actually feasible with a congenital short or absent cervix, a lacerated cervix, severe scarring of the cervix, and multiple deep cervical defects.…”

“…Regardless of the rise in the rate of preterm delivery after conization, no advantage on the utilization of prophylactic cerclage can be found. 3 There is a choice of performing this procedure in a pregnant or a nonpregnant state. In the pregnant state, the cerclage is performed toward the end of the first trimester.…”

“…This strategy is ideally performed in the nonpregnant state and has the upside of shorter hospitalization and speed recovery with less postoperative morbidity. 3,4 So this review is aimed to study the effectiveness of laparoscopic cerclage in comparison with cervical cerclage by laparotomy.…”

Transabdominal Cerclage Placement in a Gravid Patient at Week 22 of Gestation Period: A Case Report and Review of the Literature

“…Emergency cerclage placement seems to be effective in prolonging pregnancy. In a small randomized trial, prolongation time was up to 4 weeks [16], while in other observational studies it ranged between 6 and 9 weeks, compared to that of conservative treatment [bed rest] [ [16][17][18][19]. However, these studies included mostly TVC cases.…”