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

Abstract

Objective: To evaluate gynecological and obstetrical outcomes, as well as remaining myometrial thickness, after laparoscopic repair of a cesarean scar.

Design: Observational study and prospective evaluation of the remaining myometrium before and after repair.

Setting: Academic department in a university hospital.

Patient(s): A series of 38 symptomatic women with cesarean scar defects and remaining myometrial thickness of less than 3 mm, according to magnetic resonance imaging.

Intervention(s): Laparoscopic repair of the defect.

Main outcomes measure(s): Increase in myometrial thickness at the site of cesarean section, gynecological and obstetrical outcomes, and histological analysis of the defect after excision.

Result(s): The mean thickness of the myometrium increased significantly from 1.43 ± 0.7 mm before surgery to 9.62 ± 1.8 mm after surgery. All but three patients were free of symptoms. Among the 18 women with infertility, eight (44%) became pregnant and delivered healthy babies by cesarean section at 38-39 weeks of gestation. Histological analysis, performed in all 38 cases, revealed the presence of endometriosis in eight women (21.1%). Muscle fiber density was significantly lower compared with adjacent myometrium.

Conclusion(s): In symptomatic women with residual myometrial thickness of less than 3 mm who wish to conceive, laparoscopic repair could be considered an appropriate approach.

Keywords: Cesarean scar defect; hysteroscopy; laparoscopic repair; myometrial thickness; niche.