Surgical management of isthmocele symptom relief and fertility

Enderle, Isabelle; Dion, Ludivine; Bauville, Estelle; Moquet, Pierre-Yves; Lévèque, Jean; Lavoué, Vincent; Lous, Maëla Le; Nyangoh-Timoh, Krystel

doi:10.1016/j.ejogrb.2020.01.028

Cited by 20 publications

(29 citation statements)

References 19 publications

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“…In the prospective or retrospective case series, the overall pregnancy rate across all interventions was 132 of 206 (64.1%). Pregnancy rates could not be calculated for each intervention across all studies owing to incomplete reporting in 1 study [17]. Exclusion of that study (10 patients) resulted in pregnancy rates of 105 of 156 (67%) for hysteroscopy, 18 of 36 (50%) for laparoscopy, and 3 of 4 (75%) for laparotomy.…”

Section: Fertility Outcomesmentioning

confidence: 99%

“…From the review of the article, it appears that only one of the patients who underwent a repeat surgery desired fertility and conceived after the second procedure. In another study, 1 patient had a bladder injury during a vaginal approach [17]. This was immediately identified and repaired, with no mention of ongoing complications.…”

Section: Adverse Events and Complicationsmentioning

confidence: 99%

“…In the only study using a vaginal approach, the cervix was visualized, and an anterior incision was made from the 3 o'clock to 9 o'clock position at a distance 0.5 cm inferior to the vesicocervical area [17]. The cervical and lower uterine segments were exposed followed by the insertion of a uterine probe through the cervix.…”

Section: Surgical Approachesmentioning

confidence: 99%

“…The fibrous fascia was then dissected to allow full access to the defect. The scar tissue was removed using a knife to expose bleeding muscle before double layer closure [17]. The procedure was not well described in the other study using laparotomy [19].…”

Section: Surgical Approachesmentioning

confidence: 99%

“…There were 2 studies that reported outcomes for multiple surgical approaches [16,17]. One of these studies was retrospective, and no rationale was provided for the choice of approach [17].…”

Section: Surgical Approachesmentioning

confidence: 99%

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Reproductive Outcomes Following Surgical Management for Isthmoceles: A Systematic Review

Harjee¹,

Khinda²

2021

Journal of Minimally Invasive Gynecology

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Objective: To evaluate the efficacy of surgical management for isthmoceles in patients presenting with secondary infertility. Data Sources: A systematic search was performed in MEDLINE, EMBASE, and Cochrane Library databases from inception to May 2020. The search was limited to studies published in English. Methods of Study Selection: After the removal of duplicates, 3380 articles were screened for inclusion independently by 2 authors. These 2 authors assessed for studies which focused on women of reproductive age with a diagnosed isthmocele and secondary infertility who underwent any surgical intervention for defect repair with at least 1 of the goals being fertility restoration. Tabulation, Integration, and Results: A total of 13 studies, comprising of 1 randomized controlled trial, 6 prospective case series, and 6 retrospective case series describing 234 patients who underwent surgical management for an isthmocele and secondary infertility were included. The methodologic quality of the included studies was assessed independently by both reviewers. Next, the data extraction was performed independently and then compared to ensure no discrepancies. A total of 188 patients were treated by hysteroscopy, 36 by laparoscopy, 7 by laparotomy, and 3 through a vaginal approach. In total, 153 of the 234 patients (65.4%) achieved pregnancy across all studies within their respective study periods. Pregnancy rates in the randomized controlled trial were 21 of 28 (75%) for those treated by hysteroscopy compared with 9 of 28 (32%) for those untreated. Among the studies reporting pregnancy outcomes, 101 of 116 (87.1%) pregnancies resulted in a live birth. The incidence of adverse events was 2%, including the risk of reoperation. Conclusion:The results of this systematic review suggest that the surgical treatment of an isthmocele, particularly through hysteroscopy, in patients with residual myometrial thickness of at least 2.5 mm, may be effective in treating isthmoceleassociated secondary infertility with a relatively low complication rate. Further high-quality studies are needed because of the small sample sizes and observational nature of most available data.

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Section: Fertility Outcomesmentioning

confidence: 99%

Section: Adverse Events and Complicationsmentioning

confidence: 99%

Section: Surgical Approachesmentioning

confidence: 99%

Section: Surgical Approachesmentioning

confidence: 99%

Section: Surgical Approachesmentioning

confidence: 99%

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Reproductive Outcomes Following Surgical Management for Isthmoceles: A Systematic Review

Harjee¹,

Khinda²

2021

Journal of Minimally Invasive Gynecology

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Cesarean scar niche: An evolving concern in clinical practice

Armstrong

Mulligan

Dermott

et al. 2022

Intl J Gynecology & Obste

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Cesarean sections have increased worldwide and there is an increasing awareness of the adverse long-term sequelae associated with the procedure. The World Health Organization estimates that there are approximately 18.5 million women who undergo this procedure annually, with rates in the Western world increasing from 14.5% to 27.2% between the years 2000 and 2017. 1 A cesarean scar niche, first described in 1961 when a wedgeshaped defect was noted in the uterine wall of a patient who had previously had a cesarean section during hysterosalpingography, 2 is defined as the presence of a hypoechoic area and discontinuation

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Assessment of the clinical outcomes and complications of hysteroscopic and laparoscopic approaches in the treatment of symptomatic isthmocele: An observational study

Fatehnejad

Hadizadeh

Tayebi

et al. 2023

Intl J Gynecology & Obste

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ObjectivesTo investigate the outcomes of patients undergoing laparoscopic or hysteroscopic approaches for isthmoplasty.MethodsA total of 99 isthmocele patients with an average age of 38.45 ± 4.72 years were included in the 2 years of this retrospective cohort study. Forty‐five underwent laparoscopic and 54 underwent hysteroscopic isthmocele excision and myometrial repair.ResultsPain scores were significantly higher in the hysteroscopy group before the procedure, but there were no significant pain score differences after the surgery. In 1 year of follow up, dysmenorrhea and dyspareunia were higher among hysteroscopy patients. Furthermore, hysteroscopy significantly improved postmenstrual spotting after surgery better than laparoscopy, but in the follow up, there was no significant difference between the two groups in this regard (mean rank for hysteroscopy vs. laparoscopy: 32.30 vs. 37.48, U = 418, P = 0.29).ConclusionIn patients with a history of infertility, ectopic pregnancy, lower gravidity, lower parity, and a lower number of cesarean sections, laparoscopic isthmoplasty is preferred over the hysteroscopic approach. Both methods have similar effects on midcycle vaginal bleeding, duration of postmenstrual spotting, and pain. However, a higher rate of dyspareunia and dysmenorrhea could be associated with hysteroscopy.

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Surgical management of isthmocele symptom relief and fertility

Abstract: Total n = 18 patients Age (median (min-max)) 36 (30-45) Gravidity (median (min-max)) 2 (1-7) Parity (median (min-max)) 2 (1-3) Number of caesarean (median (min-max)) 2 (1-3)

Cited by 20 publications

References 19 publications

Reproductive Outcomes Following Surgical Management for Isthmoceles: A Systematic Review

Reproductive Outcomes Following Surgical Management for Isthmoceles: A Systematic Review

Cesarean scar niche: An evolving concern in clinical practice

Assessment of the clinical outcomes and complications of hysteroscopic and laparoscopic approaches in the treatment of symptomatic isthmocele: An observational study

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