Laparoscopic Repair of Uterine Scar Dehiscence After Cesarean Section

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

“…Methods of operative repair of uterine diverticulum include hysteroscopy, laparoscopy, vaginal repair, and the combined use of hysteroscopy and laparoscopy. The choice of the surgical approach is mainly based on the clinical features and surgical skills of the operating team [ 16 , 17 ]. Once a scar defect is confirmed, microsurgical reconstruction of the uterine diverticulum can partly attenuate symptoms such as postmenstrual spotting, abdominal pain, and infertility [ 17 ].…”

“…Klemm et al [ 15 ] proposed that ineffective drug therapy could be replaced by surgical repair using hysteroscopy combined with laparoscopy and that this combined approach is more effective and safe, as it allows superior visualization of the diverticulum, which, in turn, helps to improve the accuracy of orientation. A more recent study [ 16 ] reported significant clinical improvement in 14 patients with uterine incision diverticulum who underwent combined hysteroscopic and laparoscopic repair.…”

“…Third, hysteroscopy makes use of an orange-red light source for guidance to accurately determine the location and extent of the diverticulum. Fourth, after resection of the diverticulum at laparoscopy, surgical repair can be confirmed by hysteroscopy, thus minimizing the risk of complications [ 16 ]. Clearly two techniques are better than one, but not always, for combined approach of hysteroscopy with laparoscopy might have a higher fee and need more surgery time, and the operating surgeon must be familiar with the sight of diverticulum under both laparoscopy and hysteroscopy.…”

Combined correction of the local post cesarean scar insufficiency

“…Однако следует отметить, что микрохирургическая реконструкция, включающая только лапароскопию, имеет свои недостатки, такие как плохая визуализация и, следовательно, низкая точность определения «ниши», расположенной со стороны эндометрия. Ранее сообщалось о значительном клиническом улучшении у 14 пациентов с наличием несостоятельности рубца на стенке матки в виде «ниши», которым проводили комбинированную гистероскопическую и лапароскопическую реконструкцию [15]. Нами также выбран комбинированный подход.…”