A Comparison of Vaginal Surgery and Operative Hysteroscopy for the Treatment of Cesarean-Induced Isthmocele: A Retrospective Review

Abstract

Background/Aims: Cesarean-induced isthmocele can cause heavy or prolonged menses, dyspareunia, and dysmenorrhea. We compared the efficacy of vaginal surgery and operative hysteroscopy for the treatment of cesarean-induced isthmocele. Methods: Seventy-seven women with cesarean-induced isthmocele underwent either vaginal surgery or operative hysteroscopy between August 2008 and December 2011. We evaluated operating time, blood loss, complications, and postoperative pregnancy. Operative efficacy was defined as an improvement in menstrual periods and a change in residual isthmocele nidus size on transvaginal ultrasonography. Results: The operative efficacy of vaginal surgery was superior to that of hysteroscopy (93.5 vs. 64.5%; p < 0.001). However, patients who underwent vaginal surgery had a longer operative time (55 vs. 25 min; p < 0.001) and greater blood loss (50 vs. 10 ml; p < 0.001). Two patients in each group were able to achieve subsequent pregnancy. Patients who had menstrual periods longer than 7 days after surgery were more likely to have a residual nidus. Conclusions: The therapeutic efficacy of vaginal surgery is superior to operative hysteroscopy in the treatment of cesarean-induced isthmocele.

Hysteroscopic Treatment of Symptomatic Cesarean-induced Isthmocele: A Prospective Study

“…Since then, several authors have adopted different surgical techniques to treat CSD, including laparoscopic excision [17], a combined laparoscopic-vaginal approach, and a purely vaginal approach [18].…”

Laparoscopic combined with hysteroscopic repair or operative hysteroscopy in the treatment of symptomatic cesarean-induced diverticulum

“…The treatment efficacy of post-operative menstruation duration of both groups are summarized in Table 2. The median change was 6.7 days (4-10) in laparoscopic combined with hysteroscopic group (P<0.001), and 7.7 (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14) in the operative hysteroscopy group (p<0.001). The 20 non-improved patients started their postmenstrual bleeding within 3 months after surgery.…”

“…Some inexperienced doctors, especially from the underdeveloped communities hardly notice this defect. Currently, the treatment of this diverticulum may be performed by laparoscopic, combined laparoscopic vaginal surgery or vaginal surgery and operative hysteroscopy, transabdominal or transvaginal, all minimally invasive approaches to improve symptoms and restore fertility [5,6]. However, there is no guideline to indicate which technique should be selected.…”

The effect of surgery on subsequent pregnancy outcomes among patients with cesarean scar diverticulum

“…Nonetheless, surgical intervention often causes increased trauma to the patient; has a longer recovery period and operative delivery interval compared with patients who do not undergo surgery; and can cause operative complications, including intraoperative bleeding, infection, organ damage, or adhesion. The level of surgical experience might also influence outcomes as residual or new lesions have been reported among some patients after surgery . Whether surgical treatment is required for all patients with CSD who desire subsequent pregnancy is unclear, particularly among women without severe symptoms or secondary infertility.…”

“…The level of surgical experience might also influence outcomes as residual or new lesions have been reported among some patients after surgery. 11 Whether surgical treatment is required for all patients with CSD who desire subsequent pregnancy is unclear, particularly among women without severe symptoms or secondary infertility. In addition, it is unknown whether surgery decreases the risk of adverse outcomes during the subsequent pregnancy.…”