Complications of Laparoscopic and Transabdominal Cerclage in Patients with Cervical Insufficiency: A Systematic Review and Meta-analysis

Abstract

Cervical insufficiency is a defect of the cervix that leads to failure to preserve a full-term intrauterine pregnancy.Laparoscopic cerclage and open transabdominal cerclage (TAC) are effective ways to manage patients with cervical insufficiency. We performed this systematic review and meta-analysis to investigate the complications of laparoscopic cerclage and open TAC in the management of cervical insufficiency. Data Sources: We searched PubMed, Cochrane, Scopus, and Web of Science using our search strategy and screened the results for our criteria. We extracted the results reported and analyzed them using Open Meta-Analyst (OpenMeta[Analyst], Brown School of Public Health, Providence, RI) and Review Manager (Cochrane Collaboration, London, United Kingdom) software. Methods of Study Selection:We included all randomized controlled and observational trials performed on patients with cervical insufficiency undergoing open TAC or laparoscopic cerclage that matched our search strategy. We excluded letters to the editor, reviews, meetings/conference abstracts, non-English or nonhuman studies, and instances where the full text was not available. Tabulation, Integration, and Results: We included a total of 33 trials. Both interventions of laparoscopic cerclage and open TAC were associated with significantly less total fetal loss (laparoscopic cerclage, relative risk [RR] 0.03; 95% confidence interval [CI], 0.01−0.08; p <.001, and open TAC, RR 0.19; 95% CI, 0.07−0.51; p <.009). The overall blood loss in open TAC was 110.589 mL (95% CI, 93.737−127.44; p <.001), and in laparoscopic cerclage, it was 24.549 mL (95% CI, 9.892−39.205; p = .001). In addition, open TAC had a positive effect regarding incidence of hemorrhage >400 mL (RR 0.077; 95% CI, 0.033−0.122; p <.001). Preterm premature rupture of membranes was significant in the open TAC (RR 0.037; 95% CI, 0.019−0.055; p <.001) and laparoscopic cerclage groups (RR 0.031; 95% CI, 0.009−0.053; p = .006). Conclusion: Laparoscopic cerclage may be safer than open TAC in the management of cervical insufficiency because we found a statistically significant lower incidence of fetal loss, blood loss, and rate of hemorrhage in the laparoscopic cerclage group. Clinically, this evidence may help support favoring a laparoscopic approach over an open one in appropriate patients, although it is unclear whether this benefit is limited to cerclages placed either before pregnancy or placed in the first-trimester or both.

Comparison of transvaginal cervical cerclage versus laparoscopic abdominal cervical cerclage in cervical insufficiency: a retrospective study from a single centre

“…Moreover, TAC avoids the infection risk of vaginal surgery and movement restrictions after surgery, and patients can take care of their duration of pregnancy by themselves. A recent systematic review extrapolated that LAC is a reasonable alternative to open TAC and may be preferable because of benefits such as cosmesis and recovery [ 18 ]. Therefore, an increasing number of researchers prefer to concentrate on the benefits of LAC before pregnancy or during the first trimester.…”

Laparoscopic cerclage – an effective method of treating cervical insufficiency

“…При таких показаниях возможно проведение трансабдоминального серкляжа (ТАС), который может быть осуществлен с помощью лапаротомной, лапароскопической или роботической техники до или после зачатия (до 14 нед.) [13][14][15][16][17][18][19][20][21].…”

“…при проведении ТАС, первый был связан со снижением постоперационных осложнений со стороны матери, в т. ч. с меньшей кровопотерей (при лапароскопической операции она составляет 24,549 мл, в то время как при лапаротомной -110,589 мл), низким риском послеоперационных тромбозов глубоких вен, снижением болей от оперативного вмешательства, укорочением пребывания в стационаре (менее суток в случае лапароскопического ТАС) и лучшим косметическим эффектом [11,13]. Относительно вынашивания и зачатия также есть свидетельства в пользу лапароскопической техники: в группе пациенток, которым проводился лапароскопический серкляж до зачатия, уровень зачатия составил 77,8% против 74,2% при лапаротомном вмешательстве, а выкидыш, ассоциированный с операцией, при лапароскопии и при лапаротомии происходил в 1,2 и 3% соответственно.…”

Removal of laparoscopic cerclage stitches via laparotomy and rivanol-induced labour: A case report and literature review

“…However, for patients with foetal abnormalities or second- or third-trimester foetal death, the method of removing the stitches to allow for labour induction remains controversial. In all previous cases of laparoscopic cerclage, labour induction was implemented in the second trimester, and cerclage stitches were removed either laparoscopically or transvaginally[ 5 - 10 ].…”