Laparoscopic repair of uterine rupture after delivery: A comprehensive evaluation of the uterine rupture management, with a proposal surgical method

被引：0

作者：

Pecorella, Giovanni ^{[1
,2
]}

Licchelli, Martina ^{[1
,2
]}

Panese, Gaetano ^{[1
,2
]}

Morciano, Andrea ^{[3
]}

Sparic, Radmila ^{[4
,5
]}

Kosmas, Ioannis ^{[6
]}

De Rosa, Filippo ^{[2
,7
]}

Malvasi, Antonio ^{[8
]}

Tinelli, Andrea ^{[1
,2
]}

机构：

[1] Veris delli Ponti Hosp, Dept Obstet & Gynecol, Lecce, Italy

[2] Veris delli Ponti Hosp, CERICSAL Ctr Ric Clin SALentino, Lecce, Italy

[3] Pia Fdn Card G Panico, Panico Pelv Floor Ctr, Dept Gynaecol & Obstet, Lecce, Italy

[4] Univ Belgrade, Fac Med, Belgrade, Serbia

[5] Univ Clin Ctr Serbia, Clin Obstet & Gynecol, Belgrade, Serbia

[6] Ioannina State Gen Hosp G Chatzikosta, Dept Obstet & Gynecol, Ioannina, Greece

[7] Veris delli Ponti Hosp, Dept Anesthesia & Intens Care, Lecce, Italy

[8] Univ Aldo Moro, Dept Interdisciplinary Med DIM, Unit Obstet & Gynecol, Bari, Italy

来源：

INTERNATIONAL JOURNAL OF GYNECOLOGY & OBSTETRICS | 2025年

关键词：

barbed sutures; CHEESE method; laparoscopic repair; minimally invasive surgery; postoperative follow-up; single-layer suture; uterine rupture; VAGINAL BIRTH; INTRACAPSULAR MYOMECTOMY; CESAREAN DELIVERY; SEGMENT THICKNESS; RISK; LABOR; RECOMMENDATIONS; SALPINGECTOMY; COMPLICATIONS; PREGNANCY;

D O I：

10.1002/ijgo.70066

中图分类号：

R71 [妇产科学];

学科分类号：

100211 ;

摘要：

Uterine rupture constitutes a critical obstetric emergency that presents substantial risks to both the maternal and fetal populations. This investigation evaluated the surgical interventions available for uterine rupture, emphasizing laparoscopic repair subsequent to uterine rupture. Laparoscopic repair serves as a fertility-sustaining alternative to conventional laparotomy, demonstrating comparable operative durations of 80 min (interquartile range [IQR] 60-114) for laparoscopic procedures versus 78 min (IQR 58-114) for laparotomy interventions. Nevertheless, laparoscopic approaches confer significant advantages, including a reduced incidence of intensive care unit (ICU) admissions (14.2% vs. 40% for laparotomy), a diminished requirement for blood transfusions (14.2% vs. 60%), and abbreviated hospital stays (median of 3 days vs. 5 days for laparotomy). The investigation explored the contentious discourse surrounding single-layer versus double-layer suturing methodologies, noting that barbed sutures significantly decrease uterine closure times (224 +/- 46 vs. 343 +/- 75 s for traditional sutures). Single-layer suturing is advocated as sufficient for maintaining uterine integrity in suitably selected cases. The necessity of meticulous postoperative monitoring, particularly concerning the assessment of recurrence in subsequent pregnancies, is emphasized, with recurrence rates varying from 4.8% to 19.4%. Finally, authors also proposed a feasible laparoscopic technique to repair a uterine rupture (the "CHEESE" method [closure of hemodynamically stable, early uterine rupture, via endoscopic surgery after spontaneous delivery]), appropriate for hemodynamically stable patients with minor ruptures. This review underscores the progressive role of minimally invasive techniques in the management of uterine rupture and seeks to optimize clinical outcomes for both maternal and neonatal health.

引用

页数：10