Laparoscopic prepregnancy transabdominal cerclage: operative and pregnancy outcomes for a novel technique of suture placement using port closure device

Abstract

Trans-abdominal cerclage (TAC) is an effective surgical intervention for preterm birth prevention. Placement of cervical suture using port closure device for pre-pregnancy laparoscopic abdominal cerclage has been used at our unit in recent years. We report operative and pregnancy outcomes for pre-pregnancy laparoscopic abdominal cerclage using the port closure device compared to traditional approach.For pre-pregnancy laparoscopic TAC(n=52), the port closure device approach is associated with lower blood loss at surgery and hospital length of stay (0.95+-4.4 mls vs 5.4+-15.7mls, p=0.007; 0.0(0.0-0.0) days vs 1.0(0.0-1.0) days, p<0.001). There were also trends towards shorter operating times (41.4+-15.3 minutes versus 50.1+-18.0, p=0.167) and lower peri-operative complications (0.0%, 0/21 vs 16.1%, 5/31, p=0.065) compared to traditional technique. There was no significant difference between the port closure device technique and traditional approach in rates of preterm birth rate in subsequent pregnancy (0.0%,0/9 vs 22.6%,7/39, p=0.248).Novel use of the port closure device for suture placement at pre-pregnancy laparoscopic cerclage for preterm birth prevention. This technique is associated with lower blood loss and length of stay, has trends in shorter operating times and peri-operative complications and similar rates of preterm birth.