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Laparoscopic Cerclage in Pregnant and Nonpregnant Uterus: Emerging Need to change Conventional Management Approach
RESULTS DISCUSSION

All the cases of patients available within the limit of Cervical incompetence has been traditionally treated with
the search engines that underwent laparoscopic cer- transvaginal cerclage over the years, and this has been
clage between 2008 and 2015 were reviewed. This in the treatment of choice for the last 50 years. 3,14
total involves pregnant and nonpregnant patients – of In the majority of patients in whom cervical cerclage
403 patients of various indications, 88 (21.8%) were preg- is indicated, it can be achieved through transvaginal
nant when the procedure was done, while 315 (78.2%) procedure. In this case, the suture can be removed at
were not pregnant. 37 weeks, and a vaginal delivery can be aimed for, if there
The results are shown in Table 1. 15-25 The number of is no contraindication to vaginal delivery.
patients that were treated each year ranges from 1 to 101, The transabdominal approach of cerclage in general
with majority of the cases done before pregnancy, and, (laparotomy and laparoscopy) is essential for adequate
in all, reveals very minimal intraoperative complica- therapy in a selected population of women. This includes
tions which were seen in only three cases – 2009, 2013, those individuals in whom a satisfactory transvaginal
and 2014, with intraoperative complications of 10.7, 4.5, cerclage is not technically feasible – a congenital short
and 1.6% respectively; others did not record any form of or absent cervix, an extensively amputated cervix,
complications. There were no severe complications like marked scarring of the cervix, and multiple deep cervical
infection, severe hemorrhage, and injury of peripheral defects, and also a previously failed vaginal cerclage has
organs. been regarded as a good indication for transabdominal
The mean gestational ages at delivery were grossly cerclage.
normal, ranging between 35 and 38 weeks except for only The choice of transabdominal cerclage now depends
one of the cases that was reported by Murray et al, in 2011, on so many factors: The expertise and availability of
with the delivery at 28 weeks. It was only one case, and technical knowhow, the institutional norms, evident
the cerclage was done before pregnancy. cumulative fetal survival rate, ranging from 75 to 100%,
The survival rate at birth ranges between 75 and 100%. favorable gestational age at delivery, and the current and
All the surgeries were successful without assistance consistent successful transabdominal laparoscopic cer-
or converting to laparotomy. clage that has been reported over the last three decades,

Table 1: Results of laparoscopic cervical cerclage done between 2009 and 2015
Intraoperative Average Survival
Patient complication gestational rate at
Cerclage by laparoscopy no. Time of surgery Pregnant no. rate (%) age at birth birth (%)
Liddell and Lo 15 11 Before pregnancy 10 0 ND 100
Whittle et al 16 65 34 before pregnancy 67 10.7 35.8 80
31 during pregnancy
Fechner et al 17 1 During pregnancy 1 0 37 100
Carter et al 18 12 7 before pregnancy 12 0 ND 75
5 during pregnancy
Pereira et al 19 1 Before pregnancy 2 0 38 100
Palacio et al 20 2 Before pregnancy ND 0 ND ND
Murray et al 21 1 Before pregnancy 1 ND 28 100
DaCosta et al 22 3 Before pregnancy 2 0 37 100
Riiskjaer et al 12 52 Before pregnancy 45 0 37.4 83.3
El-Nashar et al 23 4 During pregnancy 4 ND 37.3 100
Salmeen and Parer 24 66 Before pregnancy 36 4.5 37.2 90
Ades et al 25 64 61 before pregnancy 35 1.6 35.8 95.8
3 during pregnancy
Shin et al 3 1 During pregnancy 1 0 35 100
Luo et al 11 19 Before pregnancy 15 0 38.4 90
Chen et al 4 101 58 before pregnancy 93 0 38.2 95
43 during pregnancy
ND: No data
World Journal of Laparoscopic Surgery, January-April 2017;10(1):35-39 37