Abdominal cerclage for the treatment of recurrent cervical insufficiency: laparoscopy or laparotomy?

• Published in: American journal of obstetrics and gynecology Vol. 201; no. 1; pp. 111.e1 - 111.e4
• Main Authors: Carter, James F., MD, Soper, David E., MD, Goetzl, Laura M., MD, MPH, Van Dorsten, J. Peter, MD
• Format: Journal Article Conference Proceeding
• Language: English
• Published: New York, NY Mosby, Inc 01.07.2009; Elsevier
• Subjects: Abdomen; abdominal; Abortion, Habitual - etiology; Adult; Ambulatory Surgical Procedures; Biological and medical sciences; cerclage; Cerclage, Cervical - methods; Digestive system. Abdomen; Endoscopy; Female; Gynecology. Andrology. Obstetrics; Humans; Investigative techniques, diagnostic techniques (general aspects); Laparoscopy; Laparotomy; Medical sciences; Obstetrics and Gynecology; Pregnancy; Pregnancy Outcome; Prospective Studies; Recurrence; Retrospective Studies; Uterine Cervical Incompetence - surgery; Young Adult; cerclage; abdominal; laparotomy; pregnancy; Surgical cerclage; Relapse; Treatment; Surgery; Gynecology; Laparoscopy; Uterine cervix; Endoscopy; Laparotomy; Obstetrics; Abdomen
• ISSN: 0002-9378; 1097-6868
• DOI: 10.1016/j.ajog.2009.05.033

Objective The purpose of this study was to compare the efficacy of traditional abdominal cerclage (AC) with laparoscopic cerclage (LC). Study Design Eligible women had at least 1 second trimester pregnancy loss due to cervical insufficiency, and had undergone at least 1 failed transvaginal cerclage. A prospective cohort of patients undergoing LC was compared with a historical control group of patients who had AC. A successful primary outcome was defined as delivery of a viable infant with neonatal survival. Results We were able to evaluate 19 pregnancies following unique abdominal cerclage placement, 12 laparoscopic and 7 at the time of laparotomy. Nine of 12 (75%) undergoing LC and 5 of 7 (71%) pregnancies undergoing AC successfully delivered a viable infant ( P = .63). LC during pregnancy was successful in 4 of 5 (80%) cases as compared to 3 of 5 (60%) cases with AC during pregnancy ( P = 1.0). Conclusion Operative laparoscopy is a safe and effective alternative to laparotomy for the placement of abdominal cerclage.