Comparative study on the clinical efficacy of laparoscopic cervicoisthmic cerclage and transvaginal cervical cerclage in the treatment of cervical insufficiency after hysteroscopic adhesiolysis for intrauterine adhesions: a retrospective cohort study.

INTRODUCTION

This study compared the clinical efficacy of laparoscopic cervical cerclage (LAC) and transvaginal cervical cerclage (TVC) in treating cervical insufficiency (CI) patients after hysteroscopic adhesiolysis for intrauterine adhesions (IUA).

METHODS

A total of 170 eligible patients (66 in the LAC group, 104 in the TVC group) admitted from Jan 2018 to Jan 2024 were retrospectively analyzed, with LAC performed pre-pregnancy and transvaginal McDonald cerclage performed at 12-16 weeks of gestation in the TVC group. Pregnancy outcomes and surgical safety were compared between the two groups, with subgroup analysis conducted by IUA severity.

RESULTS

Results showed that the LAC group had a significantly higher term delivery rate (89.4% vs. 71.2%, P = 0.005) and neonatal survival rate (98.5% vs. 90.4%, P = 0.027), and a lower preterm birth rate before 34 weeks (9.1% vs. 20.2%, P = 0.036) than the TVC group. In terms of safety, the LAC group had a lower infection rate (3.0% vs. 10.6%, P = 0.029) and suture slippage rate (1.5% vs. 9.6%, P = 0.015), while the TVC group had a higher cervical laceration rate (5.8% vs. 1.5%, P = 0.048). The LAC group had 2 mild intraoperative complications (1.5% each), all resolved with timely treatment, whereas the TVC group had no severe intraoperative complications. The LAC group had a markedly higher cesarean section rate (98.5% vs. 26.9%, P < 0.001). Subgroup analysis indicated that the LAC group had a significantly higher term delivery rate in moderate-to-severe IUA patients (88.1% vs. 71.0%, P = 0.005), with no significant difference in mild IUA patients (91.7% vs. 71.4%, P > 0.05). In conclusion, LAC is superior to TVC in improving the term delivery rate and reducing late miscarriage in CI patients after IUA surgery, especially for those with moderate-to-severe IUA. TVC, with minimal invasion and preserved vaginal delivery chance, is suitable for mild IUA patients with good cervical conditions and a willingness for vaginal delivery. Individualized surgical selection is recommended in clinical practice.