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

OBJECTIVE Cervical insufficiency (CI) is a defect of the cervix that leads to failure to preserve a full-term intrauterine pregnancy. Laparoscopic and open transabdominal cerclage (TAC) are effective ways to manage patients with CI. We performed this systematic review and meta-analysis to investigate the complications of laparoscopic and open TAC in the management of CI. 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 using Open Meta-Analyst and Review Manager Software. METHODS OF STUDY SELECTION We included all randomized controlled and observational trials performed on patients with CI undergoing open TAC or laparoscopic cerclage that matched our search strategy. We excluded letters to the editor, reviews, meetings/conference abstracts, non-English or non-human 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 and open TAC were associated with significantly less total fetal loss; for laparoscopic (RR = 0.03, 95% CI [0.01, 0.08], P 400 ml (RR = 0.077, 95% CI [0.033, 0.122], P < 0.001). Preterm premature rupture of membranes was significant in open TAC (RR = 0.037, 95% CI [0.019, 0.055], P < 0.001) and the laparoscopic group (RR = 0.031, 95% CI [0.009, 0.053], P = 0.006). CONCLUSION Laparoscopic cerclage may be safer than open TAC in the management of CI, as we found a statistically significant lower incidence of fetal loss, blood loss, and rate of hemorrhage. Clinically this evidence may help support favoring a laparoscopic approach over open in appropriate patients, although it is unclear whether this benefit is limited to either cerclages placed prior to pregnancy, placed in the first trimester, or both.