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Technique to reduce complexity and improve safety of laparoscopic cervical cerclage, case series
  1. Y Afifi
  1. Birmingham women's hospital, Birmingham, UK

Abstract

Abdominal cerclage is a management option for patients with diagnosis of cervical incompetence and impossible or recurrent failure of vaginal cerclage. Impossible vaginal route is seen in patients with previous tracelectomy or repeat loop excision. Limited case series of laparoscopic route have been published with different techniques. The authors reported significant modification of the technique of laparoscopic abdominal cerclage aiming to reduce the complexity and improve the safety of the procedure. This technique aims to overcome the problems of space limitation, the risk of energy use, the precision of placement of stitch and option of reversibility in case of early spontaneous abortion. 11 cases underwent laparoscopic cerclage with this technique and complete follow up of the outcome were included. All patients had multidisciplinary assessment and counselling. 8 patients were referred for impossible vaginal cerclage with cervix flushed with the vagina due to previous tracelectomy or repeat loop excision. 3 patients were referred for previous failure of vaginal route. No significant intraoperative or postoperative complications were reported. Mean operative time was 70 min and blood loss was less than 100 ml in all patients. 8 of the 11 patients had elective caesarean section at 39 weeks, 1 patient had emergency section at 35 weeks and 1 patient delivered at 26 weeks. This gives 81% success rate (delivery >34 weeks). 1 patient had 14 weeks spontaneous abortion where the stitch was removed laparoscopically before surgical evacuation. This case series indicated that this technique is safe and successful in patients need abdominal cerclage.

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