Laparoscopic cervico-isthmic cerclage: About 25 cases

Area of Science:

• Reproductive Medicine
• Minimally Invasive Surgery
• Maternal-Fetal Medicine

Background:

• Recurrent pregnancy loss and cervical insufficiency pose significant challenges in reproductive health.
• Traditional surgical interventions for cervical cerclage may have limitations.
• Laparoscopic approaches offer potential advantages in terms of precision and recovery.

Purpose of the Study:

• To evaluate the efficacy and outcomes of laparoscopic cervico-isthmic cerclage.
• To report on the surgical experience and pregnancy results following this procedure.
• To assess the impact on neonatal survival rates in patients with a history of pregnancy loss.

Main Methods:

• A retrospective monocentric study of 25 cases of laparoscopic cerclage performed outside of pregnancy.
• Utilized the Dubuisson technique at the University Hospital of Clermont-Ferrand over a 13-year period.
• Collected data on pre- and post-cerclage pregnancy outcomes and surgical characteristics.

Main Results:

• Laparoscopic cerclage significantly increased the overall neonatal survival rate to 76.2% compared to 16.2% before surgery (p<0.0001).
• Neonatal survival beyond the first trimester improved to 100% post-cerclage versus 21.6% previously (p<0.0001).
• The procedure, averaging 54 minutes with a 24-hour hospital stay, allowed for concurrent treatment of other gynecological pathologies.

Conclusions:

• Laparoscopic cervico-isthmic cerclage is an effective surgical option for improving pregnancy outcomes in women with cervical insufficiency.
• The procedure demonstrates a substantial increase in neonatal survival rates, particularly for pregnancies extending beyond the first trimester.
• Laparoscopy offers the advantage of addressing associated gynecological conditions during the same surgical session.