Feasibility of laparoscopic abdominal cerclage in the second trimester

Abstract

Objective To describe a simplified laparoscopic approach to cervical cerclage in the early second trimester. Design A case study. Setting Gynaecological Endoscopy Unit, Assiut University Hospital, Assiut, Egypt. Subject A 31-year-old-patient, para 5, gravida 11, with a history of eight cervical cerclage operations performed using Shirodkar and McDonald techniques. Interventions A laparoscopic abdominal cerclage procedure was carried out by fixation of a Mersilene tape into the cervical isthmus at the 12 o’clock position. The stitch was advanced at each side and passed underneath the round ligament after freeing of the bladder. The stitch was tightened posteriorly after appropriate visualization using a fan-shaped retractor. Main outcome measures Continuation of the pregnancy after 36 weeks. Results The patient delivered a healthy 3150-g female baby at 37 weeks by repeat Caesarean section and the stitch was left in place. Conclusions Laparoscopic abdominal cerclage in the early second trimester is technically feasible without deleterious effects on the mother or the fetus. Randomized studies are required to compare the cost-effectiveness, fetal and maternal safety, feasibility and success of laparoscopic vs. open abdominal cerclage.