Long-term sequelae of abdominal cervical cerclage and a minimally invasive approach to resolution

Abstract

Cervical incompetence is diagnosed in 0.1-1% of all pregnancies and in 8% of women with repeated midtrimester pregnancy loss. This condition may be managed by the application of a suture around the cervix, placed vaginally, abdominally, or laparoscopically. The case histories of two patients are presented, both of whom had abdominal cervical cerclage applied via laparotomy 4 and 6 years previously. Counselling and decision making processes are discussed, and the operative reports of the successful laparoscopic total removal of the cervical sutures are described. Published cases of laparoscopic cerclage removal are rare; indeed only four cases have been recorded. Three of these involved the removal of the suture after a very short period of time (5-7 weeks) with one further report of a partial removal being achieved laparoscopically. We have described successful laparoscopic total removal of two abdominally placed cervical sutures that had been in-situ for a prolonged period of time. In a unit with skilled laparoscopic surgeons and high-risk obstetricians, the potential for laparoscopic insertion and removal of abdominal cervical sutures exists.

Robot-assisted laparoscopic cervical cerclage as an interval procedure

“…It is reported to complicate approximately 1% of the obstetric population [4] and contributes to 8% of recurrent second trimester losses [5]. Cervical cerclage is a surgical technique for the management of cervical insufficiency whereby a suture is placed around the cervix, as close as possible to the internal os, enclosing it and thus reinforcing the cervix mechanically at the level of the internal os which is therefore physiologic [6]. A nonabsorbable suture such as silk, monofilament or 5-mm Mersilene tape is used according to the surgeon's preference [7].…”