Hysteroscopic Treatment of Postcesarean Scar Defect

Feng, Ying; Li, Mengxiong; Liang, Xiaoqin; Li, Xiaomao

doi:10.1016/j.jmig.2012.03.010

Cited by 91 publications

(67 citation statements)

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“…In our opinion, in postmenstrual bleeding disorders, when family planning is not yet concluded, surgical correction should generally be the first-line option [4, 12, 31–33, 47]. The hysteroscopic isthmocele excision can only be planned when the patient does not plan further pregnancies [9, 48]. With the use of hysteroscopy the risk of pre- and intrapartum uterine rupture due to thinning of the myometrium increases.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic isthmocele treatment - single center experience.

Ciebiera

Czekańska-Rawska

et al. 2017

Videosurgery and Other Miniinvasive Techniques

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IntroductionA cesarean section is the most frequently performed surgery in modern obstetrics. In case of an incorrect wound healing process there is a risk of a persistent uterine wall defect. Nowadays, due to the high frequency of cesarean sections, obstetricians have to deal with the threat of uterine rupture due to pathological wound healing. It has been proven that isthmocele can cause abnormal uterine bleeding (AUB), pelvic pain (PP), and secondary infertility (SI), and can be a place of improper pregnancy placement.AimThis article presents our experience with isthmocele treatment. We describe our diagnostic process scheme, method of corrective surgery and main therapeutic outcomes.Material and methodsIn this manuscript we present a single center’s experience in isthmocele therapy. We have operated on 16 patients who suffered from abnormal uterine bleeding, pain disorders or secondary infertility possibly due to a cesarean scar defect.ResultsThe results obtained in our center are promising. In 9 of 11 (81.8%) women with abnormal bleeding we obtained complete resolution of symptoms. We had slightly worse results in the case of pelvic pain. In 4 (66.6%) of 6 patients the pain resolved completely. We have obtained 7 pregnancies in 11 (63.6%) patients operated on due to secondary infertility.ConclusionsIn our opinion, laparoscopic treatment seems to be currently one of the most effective methods in isthmocele therapy. Further investigation is necessary to determine the indications for surgery, suitable treatment strategies and appropriate care.

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Section: Discussionmentioning

confidence: 99%

Laparoscopic isthmocele treatment - single center experience.

Ciebiera

Czekańska-Rawska

et al. 2017

Videosurgery and Other Miniinvasive Techniques

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“…Operative hysteroscopy has been shown to improve the symptoms associated with isthmocele in many studies [3,5,6,7,13,14], although the percentage of patients in these studies with postoperative symptoms varies. According to reports by Chang et al [5] and Wang et al [6], about 40% of patients still have symptoms of postmenstrual abnormal uterine bleeding after hysteroscopy, although Gubbini et al [7] reported that isthmoplasty resolves abnormal postmenstrual uterine bleeding in all patients.…”

Section: Discussionmentioning

confidence: 99%

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

Xie

Fan

et al. 2014

Gynecol Obstet Invest

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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.

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“…A hysteroscopic niche resection is the least invasive of these techniques, but requires a sufficient thick residual myometrium between the niche and the bladder to prevent bladder injury 13. A hysteroscopic niche resection can be performed in different ways: the lower rim (closest to the external cervical os) can be resected to facilitate menstrual outflow (Figure1);14, 15, 16, 17 both the lower and the upper part of the niche can be resected;18, 19, 20, 21 and this can be combined with coagulation of the vessels in the niche,16, 18, 19, 20, 21 or the entire niche surface 14, 15. Previous cohort studies reported a reduction of postmenstrual spotting in 80–90% of women, and a reduction in pain in 97% of women, in the absence of complications 13, 22, 23.…”

Section: Introductionmentioning

confidence: 99%

Hysteroscopic resection of a uterine caesarean scar defect (niche) in women with postmenstrual spotting: a randomised controlled trial

Vervoort

Voet

Hehenkamp

et al. 2017

BJOG

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ObjectiveTo compare the effectiveness of a hysteroscopic niche resection versus no treatment in women with postmenstrual spotting and a uterine caesarean scar defect.DesignMulticentre randomised controlled trial.SettingEleven hospitals collaborating in a consortium for women's health research in the Netherlands.PopulationWomen reporting postmenstrual spotting after a caesarean section who had a niche with a residual myometrium of ≥3 mm, measured during sonohysterography.MethodsWomen were randomly allocated to hysteroscopic niche resection or expectant management for 6 months.Main outcome measuresThe primary outcome was the number of days of postmenstrual spotting 6 months after randomisation. Secondary outcomes were spotting at the end of menstruation, intermenstrual spotting, dysuria, sonographic niche measurements, surgical parameters, quality of life, women's satisfaction, sexual function, and additional therapy. Outcomes were measured at 3 months and, except for niche measurements, also at 6 months after randomisation.ResultsWe randomised 52 women to hysteroscopic niche resection and 51 women to expectant management. The median number of days of postmenstrual spotting at baseline was 8 days in both groups. At 6 months after randomisation, the median number of days of postmenstrual spotting was 4 days (interquartile range, IQR 2–7 days) in the intervention group and 7 days (IQR 3–10 days) in the control group (P = 0.04); on a scale of 0–10, discomfort as a result of spotting had a median score of 2 (IQR 0–7) in the intervention group, compared with 7 (IQR 0–8) in the control group (P = 0.02).ConclusionsIn women with a niche with a residual myometrium of ≥3 mm, hysteroscopic niche resection reduced postmenstrual spotting and spotting‐related discomfort.Tweetable abstractA hysteroscopic niche resection is an effective treatment to reduce niche‐related spotting.

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Hysteroscopic Treatment of Postcesarean Scar Defect

Cited by 91 publications

References 10 publications

Laparoscopic isthmocele treatment - single center experience.

Laparoscopic isthmocele treatment - single center experience.

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

Hysteroscopic resection of a uterine caesarean scar defect (niche) in women with postmenstrual spotting: a randomised controlled trial

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