Vaginal repaired cesarean section diverticulum is beneficial in women with two prior cesarean sections

Abstract

Background: The aim of this study was to evaluate the effect of vaginal repair in patients with cesarean section diverticulum (CSD) who had one or two previous cesarean sections (CSs). Methods: From January 2012 to December 2014, 248 women with CSD underwent vaginal repair surgery in Shanghai First Maternity and Infant Hospital. These included 193 women with one previous cesarean section and 55 women with two previous cesarean sections. Excision and suture of CSD was performed through a vaginal approach. The duration of menstruation, the length, width and depth of the CSD and thickness of the remaining muscular layer (TRM) were evaluated before and after surgery by transvaginal three-dimensional (3D) color Doppler ultrasound. Results: A total of 221 (89.11%) women were followed-up for more than 3 months, and 168 (67.74%) women were followed-up for more than 6 months. There were significant differences in the average duration of menstruation (7.77 ± 2.05 and 8.02 ± 2.06 days VS 13.99 ± 3.71 days), the average size of CSD (5.54*9.19*5.60 and 5.75*9.04*6.18 mm VS 7.99*12.43*6.62 mm) and the TRM (7.61 ± 2.52 and 7.60 ± 3.00 mm VS 2.51 ± 1.02 mm) after surgery compared with those figures before surgery. The results of this study reveal that vaginal repair could shorten the duration of menstruation and improve anatomical defects (P < 0.05). Moreover, there was no significant difference in the effect of clinical repair between women with one or two previous cesarean sections (P > 0.05). Conclusion: In CSD patients, the clinical effectiveness of vaginal repair was equivalent between women with one or two previous cesarean sections.

Transvaginal Isthmocele Repair With Temporary Occlusion of Uterine Vessels in Caesarean Scar Pregnancy

“…Because of the two-child policy, if the patient has undergone a first caesarean section, caesarean scar defect (CSD) and its long-term complications have recently captured the attention of more gynecologists. Patients with Isthmocele may face problems with infertility because accumulated blood can degrade the quality of sperm and cervical mucous [ 8 ]. Operative methods in symptomatic Isthmocele advocated include hysteroscopy, laparoscopy, and vaginal repair [ 8 , 9 ].…”

“…Patients with Isthmocele may face problems with infertility because accumulated blood can degrade the quality of sperm and cervical mucous [ 8 ]. Operative methods in symptomatic Isthmocele advocated include hysteroscopy, laparoscopy, and vaginal repair [ 8 , 9 ]. Studies have indicated that amongst all surgical methods, vaginal repair for CSD is a minimally invasive procedure; it allows good exposure and accurate resection and repair of full-thickness myometrium [ 10 ].…”

Prevalence, definition, and etiology of cesarean scar defect and treatment of cesarean scar disorder: A narrative review

“…There are two arguments for suturing methods in vaginal surgery. The first is a single‐layer 108 , 109 , 110 , 111 , 112 , 113 or double‐layer 65 , 80 , 114 , 115 , 116 , 117 , 118 closure. In the case of CS, the double‐layer procedure is superior to the single‐layer procedure in avoiding CSD.…”

Vaginal Repair of Cesarean Scar Defect under Hysteroscopic Guidance

“…[ 1 ] The vaginal CSD repair technique has been reported and commonly practiced in China and overseas. [ 2 3 4 5 6 ] Like Hoang and An Nguyen, we used the hysteroscopy to illuminate the site and visualize the uterine diverticulum directly because, technically, it may sometimes be difficult to locate the CSD. This vaginal repair and suturing of CSD are easier than laparoscopic surgery.…”