56 Aborted laparoscopic cerclage due to adhesive disease after recent cesarean section

Abstract

The primary goal is to demonstrate the difference in tissue healing and adhesion formation over weeks to months after a laparotomy and to understand its impact on the feasibility of surgery. Our video is a case study of a patient's elective laparoscopic surgeries following a classical cesarean delivery. The patient, a 32-year-old G4P0130, was referred to MIS faculty by MFM for placement of a laparoscopic cerclage after classical cesarean section at 23 weeks due to cervical insufficiency. The video clips were taken in the operating room during planned procedures: laparoscopic cerclage placement at 7 weeks and 7 months following classical cesarean section. Laparoscopic cerclage was initially attempted at 7 weeks postoperative from classical cesarean section but was aborted due to dense, edematous pelvic adhesions and extreme tissue friability with ultimate concern for creating a cystotomy if the surgery had been completed. Laparoscopic cerclage was then planned for 7 months postoperative from classical cesarean section. The adhesive disease during the laparoscopic cerclage placement at 7 months postoperative from classical cesarean section was significantly improved. Findings were notable for resolved prior bowel adhesions and a well-healed classical cesarean hysterotomy defect. There were minor bladder adhesions to the uterus that were safely dissected using the Harmonic scalpel, and the laparoscopic cerclage was able to be placed in standard fashion in an overall uncomplicated procedure. Although more research is needed to study the ideal time for reoperation in setting of elective surgery after a laparotomy, our case study demonstrates the significant difference in tissue adhesions and feasibility of surgery when performing an elective surgery after a longer time interval.