Marchand Institute for Minimally Invasive Surgery, Mesa (Drs. Marchand, Masoud, Galitsky, and Sainz, and Ms. Ware, Vallejo, Anderson, King, Ruther, Brazil, Cieminski, Hopewell, and Syed).
Marchand Institute for Minimally Invasive Surgery, Mesa (Drs. Marchand, Masoud, Galitsky, and Sainz, and Ms. Ware, Vallejo, Anderson, King, Ruther, Brazil, Cieminski, Hopewell, and Syed); Arizona, and Faculty of Medicine, Fayoum University, Fayoum, Egypt (Dr. Masoud).
J Minim Invasive Gynecol. 2021 Apr;28(4):759-768.e2. doi: 10.1016/j.jmig.2020.11.014. Epub 2020 Nov 26.
Cervical insufficiency is a defect of the cervix that leads to failure to preserve a full-term intrauterine pregnancy. Laparoscopic cerclage and open transabdominal cerclage (TAC) are effective ways to manage patients with cervical insufficiency. We performed this systematic review and meta-analysis to investigate the complications of laparoscopic cerclage and open TAC in the management of cervical insufficiency.
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 them using Open Meta-Analyst (OpenMeta[Analyst], Brown School of Public Health, Providence, RI) and Review Manager (Cochrane Collaboration, London, United Kingdom) software.
We included all randomized controlled and observational trials performed on patients with cervical insufficiency undergoing open TAC or laparoscopic cerclage that matched our search strategy. We excluded letters to the editor, reviews, meetings/conference abstracts, non-English or nonhuman 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 cerclage and open TAC were associated with significantly less total fetal loss (laparoscopic cerclage, relative risk [RR] 0.03; 95% confidence interval [CI], 0.01-0.08; p <.001, and open TAC, RR 0.19; 95% CI, 0.07-0.51; p <.009). The overall blood loss in open TAC was 110.589 mL (95% CI, 93.737-127.44; p <.001), and in laparoscopic cerclage, it was 24.549 mL (95% CI, 9.892-39.205; p = .001). In addition, open TAC had a positive effect regarding incidence of hemorrhage >400 mL (RR 0.077; 95% CI, 0.033-0.122; p <.001). Preterm premature rupture of membranes was significant in the open TAC (RR 0.037; 95% CI, 0.019-0.055; p <.001) and laparoscopic cerclage groups (RR 0.031; 95% CI, 0.009-0.053; p = .006).
Laparoscopic cerclage may be safer than open TAC in the management of cervical insufficiency because we found a statistically significant lower incidence of fetal loss, blood loss, and rate of hemorrhage in the laparoscopic cerclage group. Clinically, this evidence may help support favoring a laparoscopic approach over an open one in appropriate patients, although it is unclear whether this benefit is limited to cerclages placed either before pregnancy or placed in the first-trimester or both.
宫颈机能不全是一种宫颈缺陷，可导致足月宫内妊娠失败。腹腔镜宫颈环扎术和开放式经腹宫颈环扎术（TAC）是治疗宫颈机能不全的有效方法。我们进行了这项系统评价和荟萃分析，以调查腹腔镜宫颈环扎术和开放式 TAC 在治疗宫颈机能不全中的并发症。
我们使用搜索策略在 PubMed、Cochrane、Scopus 和 Web of Science 上进行了搜索，并筛选了符合我们标准的结果。我们提取了报告的结果，并使用 Open Meta-Analyst（OpenMeta[Analyst]，普罗维登斯布朗公共卫生学院，RI）和 Review Manager（Cochrane 协作，英国伦敦）软件进行分析。
我们纳入了所有在接受开放式 TAC 或腹腔镜宫颈环扎术治疗的宫颈机能不全患者中进行的随机对照试验和观察性试验，这些试验符合我们的搜索策略。我们排除了给编辑的信件、评论、会议/会议摘要、非英语或非人类研究以及无法获得全文的情况。
表格、整合和结果：我们共纳入了 33 项试验。腹腔镜宫颈环扎术和开放式 TAC 两种干预措施均与总胎儿丢失显著减少相关（腹腔镜宫颈环扎术，相对风险 [RR] 0.03；95%置信区间 [CI]，0.01-0.08；p<.001，开放式 TAC，RR 0.19；95% CI，0.07-0.51；p<.009）。开放式 TAC 的总体出血量为 110.589 毫升（95%CI，93.737-127.44；p<.001），而腹腔镜宫颈环扎术的出血量为 24.549 毫升（95%CI，9.892-39.205；p=.001）。此外，开放式 TAC 对出血量大于 400 毫升的出血发生率有积极影响（RR 0.077；95%CI，0.033-0.122；p<.001）。开放式 TAC 中胎膜早破的发生率显著（RR 0.037；95%CI，0.019-0.055；p<.001）和腹腔镜宫颈环扎术组（RR 0.031；95%CI，0.009-0.053；p=.006）。
腹腔镜宫颈环扎术在宫颈机能不全的治疗中可能比开放式 TAC 更安全，因为我们发现腹腔镜宫颈环扎术组的胎儿丢失、出血和出血率的发生率具有统计学意义。临床上，这一证据可能有助于支持在适当的患者中支持腹腔镜方法而不是开放式方法，尽管尚不清楚这种益处是否仅限于在妊娠前或孕早期放置或两者都放置的环扎术。
