Is an abdominal cerclage indicated with a cervical myomectomy? A case report

Introduction: Cervical myomectomy can compromise cervical integrity and the risk of subsequent cervical incompetence is unclear. In this case report, the literature on cervical myomectomies is reviewed as well as that on the potential benefits of cervical cerclage. Case presentation: A 30-year-old woman, nulligravida, with a 12 cm cervical leiomyoma consulted for heavy menstrual bleeding and pelvic pain. After failure of multiple medical therapies, a laparoscopic cervical myomectomy was successfully performed after pre-operative uterine artery embolization using absorbable gelatin sponges to reduce surgical blood loss. Discussion: A concomitant laparoscopic cerclage was achieved in order to prevent cervical incompetence, given that the full thickness of the anterior cervix was penetrated during the myomectomy.
Highlights • Laparoscopic myomectomy of large cervical leiomyomas is feasible with minimal blood loss with proper preparation. • Adjuvant preoperative uterine artery embolization is an alternative to ligation when the retroperitoneum is inaccessible. • Concomitant laparoscopic cerclage is reasonable to prevent cervical insufficiency and does not alter the mode of delivery.