Efficacy of Combined Laparoscopic and Hysteroscopic Repair of Post-Cesarean Section Uterine Diverticulum: A Retrospective Analysis

Abstract

Background. Diverticulum, one of the long-term sequelae of cesarean section, can cause abnormal uterine bleeding and increase the risk of uterine scar rupture. In this study, we aimed to evaluate the efficacy of combined laparoscopic and hysteroscopic repair, a newly occurring method, treating post-cesarean section uterine scar diverticulum. Methods. Data relating to 40 patients with post-cesarean section uterine diverticulum who underwent combined laparoscopic and hysteroscopic repair were retrospectively analyzed. Preoperative clinical manifestations, size of uterine defects, thickness of the lower uterine segment (LUS), and duration of menstruation were compared with follow-up findings at 1, 3, and 6 months after surgery. Results. The average preoperative length and width of uterine diverticula and thickness of the lower uterine segment were recorded and analyzed. The average durations of menstruations at 1, 3, and 6 months after surgery were significantly shorter than the preoperative one (p < 0.05), respectively. At 6 months after surgery, the overall success improvement rate of surgery was 90% (36/40). Three patients (3/40 = 7.5%) developed partial improvement, and 1/40 (2.5%) was lost to follow-up. Conclusions. Our findings showed that combined treatment with laparoscopy and hysteroscopy was an effective method for the repair of post-cesarean section uterine diverticulum.

Gynecological and obstetrical outcomes after laparoscopic repair of a cesarean scar defect in a series of 38 women

“…These results are comparable to those obtained by Tanimura et al (24) but superior to those achieved by Chang et al (34). However, despite residual myometrial thickness being considered the best discriminating factor (9, 10, 31), this important information was missing from the last series of Zhang et al (36) and Li et al (37). Our technique is also associated with high success rates in terms of symptoms, as 91% of our patients were asymptomatic after laparoscopic repair.…”

Preliminary report on the use of a levonorgestrel intrauterine system for the treatment of intermenstrual bleeding due to previous cesarean delivery scar defect

“…The scar defect may be completely corrected, while the angle of the uterus does not limit the procedure. The success rate for this procedure has been reported to range between 90% and 100% . However, a longer operation time, a higher volume of intraoperative bleeding, the associated risks of general anesthesia and the need for qualified physicians are important factors to consider.…”

Isthmocele: an overview of diagnosis and treatment

“…Currently, the treatment options include conservative treatment based on combined estrogen and progesterone therapy and hysteroscopic, laparoscopic, or transvaginal surgical repair. 10 The objective of this review is to present an overview of the current literature on isthmocele, approaching its classification, predisposing factors for the niche development, clinical symptoms, diagnostic methods, and the current treatment options, focusing on minimally invasive approaches.…”