[Laparoscopic cervico-isthmic cerclage evaluation].
OBJECTIVE
The transabdominal cervico-isthmic cerclage could to be proposed in case of failure of vaginal cerclage, 2nd trimester fetal losses and cervical defects. The efficiency of the laparoscopic approach, more recently described, has to be demonstrated for the prevention of obstetrical accident.


METHODS
This study is a retrospective monocentric evaluation of 14 laparoscopic cervico-isthmic cerclages performed with Benson modified technique before pregnancy between 2005 and 2007. Previous obstetrical accidents, etiology of cervical incompetence and patient outcome after cerclage were compared.


RESULTS
Median age of the patients was 33.5 years; 93% had previous fetal losses or preterm delivery and 42.9% had failure of Mac Donald cerclages. The indication of laparoscopic cervico-isthmic cerclage was Mac Donald cerclage failure (six cases), and eight cases of anatomic incompatibility of Mac Donald cerclage. Mean duration of laparoscopic cervico-isthmic cerclage was 45 minutes. All patients were hospitalized on an outpatient basis. No operative complication was reported. Six women were pregnant after cerclage: five deliveries by caesarean section at term, and one first trimester foetal loss.


CONCLUSIONS
The cervico-isthmic cerclage can be easily performed by laparoscopy. The indications are strictly the same as cervico-isthmic cerclages by laparotomy. Increasing the number of term deliveries and the obstetrical outcome of these patients, the efficiency of the cervico-isthmic cerclage by laparoscopy is demonstrated.
Service de gynécologie-obstétrique, faculté de médecine, université Montpellier-I, CHU Arnaud-de-Villeneuve, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France. g.nicolet@yahoo.fr
G
G
Nicolet
M
M
Cohen
L
L
Begue
L
L
Reyftmann
P
P
Boulot
H
H
Déchaud
D000328:Adult; D023802:Cerclage, Cervical / Q000379:methods*; D002584:Cervix Uteri / Q000601:surgery; D005260:Female; D005313:Fetal Death; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D010535:Laparoscopy / Q000379:methods*; D012189:Retrospective Studies; D002581:Uterine Cervical Incompetence / Q000601:surgery*