Laparoscopic Transabdominal Cerclage for Cervical Insufficiency in the Setting of Severe Acquired Vaginal Gynatresia

Introduction: Cervical insufficiency (CI) associated with severely obstructive vaginal anatomy represents a rare and complex surgical challenge. While transabdominal cerclage (TAC) is classically indicated after failed transvaginal approaches, its laparoscopic application (LTAC) in the setting of complete vaginal obliteration remains poorly documented, particularly in low-resource settings. Case Presentation: A 33-year-old woman (G4P0) with three prior second-trimester losses presented at 10 weeks of gestation. Clinical evaluation revealed acquired concentric vaginal gynatresia, rendering the cervix completely inaccessible. To bypass this anatomical barrier and address her recurrent CI, a laparoscopic transabdominal cerclage was performed at 11 weeks using a polypropylene mesh. Results: The procedure was completed successfully with minimal blood loss and no fetal compromise. The pregnancy was prolonged from a baseline of 14 weeks in previous gestations to 30 weeks. Delivery was performed via cesarean section. Although the neonate survived only 48 hours due to extreme prematurity-related complications, the surgical goal of achieving a viable gestational age was significantly advanced. Conclusion: LTAC is a robust and feasible intervention for patients with a “hostile” vaginal vault. In regions where caustic-induced vaginal stenosis is prevalent, LTAC should be integrated into the surgical armamentarium to improve obstetric outcomes.