The laparoscopic approach of the transabdominal cerclage of the uterine cervix in case of cervical incompetence

Cervical incompetence is characterized by painless cervical dilation in the second or early in the third trimester, with prolapse or ballooning of mem branes in the vagina and expulsion of an immature fetus. Unless effectively treated, this sequence tends to recur at each pregnancy. Usually a 'purse- string' cerclage as described by McDonald, using a vaginal approach, is eff ective. If the cervix is too short for this or even absent, a transabdomina l cervicoisthmic cerclage (TCC) is indicated. After TCC an eventual pregnan cy always culminates in a Caesarean section, as the cerclage cannot be remo ved vaginally. This is, in fact, the main drawback of this technique. Objective To present the laparoscopic approach to TCC. Case history The patient was a 34-year-old woman with a history of cervical intraepithelial neoplasia and electrosurgical excision of the transformati on zone. The pregnancy following this operation ended with an immature deli very, which was attributed to cervical incompetence. Before the next pregna ncy, TCC using a laparoscopic approach was carried out. Using one 12-mm por t and two 5-mm ports, the cervix was laparoscopically freed from the bladde r. The avascular space between the ascending and descending branch of the u terine artery was penetrated and a Mersilene band was guided through, just above the level of the sacrouterine ligaments and tied. The operation laste d 40 minutes and the patient was discharged from the hospital, in a good st ate of health, the next day. Some months later she had an uneventful pregna ncy, and a healthy but growth-retarded son, weighing 1890 g, was delivered by Caesarean section at 37 weeks of gestational age. Conclusion The laparoscopic approach to TCC was successful. The growth reta rdation in the subsequent pregnancy seemed coincidental. The laparoscopic a pproach is to be preferred for a planned TCC.