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. 2017 Aug 22:23:4061-4066.
doi: 10.12659/msm.902720.

Outcomes of Laparoscopic Treatment in Women with Cesarean Scar Syndrome

Erik Dosedla  1 , Pavel Calda  2
Affiliations

Outcomes of Laparoscopic Treatment in Women with Cesarean Scar Syndrome

Erik Dosedla et al. Med Sci Monit. .

Abstract

BACKGROUND The aim of this study was to evaluate the outcomes of laparoscopic treatment of women with severe defect of a Cesarean section (CS) scar and Cesarean scar syndrome. MATERIAL AND METHODS A prospective longitudinal study was conducted in 11 women who were treated for Cesarean scar syndrome. Ultrasound examinations were performed transvaginally 1 day before surgery and 6 months after laparoscopy in all women. Clinical data were registered 1 day before laparoscopy and 6 months after laparoscopy. RESULTS Of these 11 women, total dehiscence of the CS scar was present in 72.7% (8/11) of the women. Before laparoscopy, all 11 women had severe defect of the CS scar (DRC ≤0.25); however, 6 months after laparoscopy, 81.8% (9/11) of women still had severe defect of the CS scar. Mean thickness of the CS scar, measured 1 day before and 6 months after laparoscopy in all 11 women, was 0.3±0.4 mm and 1.3±1.0 mm, respectively. Accordingly, no significant differences were observed in the mean CS scar thickness (p=0.101). After laparoscopy, 63.6% (7/11) of women were fully asymptomatic, and among the remaining 4, the most common complications were dyspareunia in 36.4% (4/11, p=0.005), pelvic pain in 27.3% (3/11, p=0.014), and dysmenorrhea in 18.2% (2/11, p=0.01), and best results after laparoscopy were achieved for postmenstrual spotting in 18.2% (2/11, p<0.001). CONCLUSIONS Improvement of women's health after laparoscopy does not necessarily mean improvement of CS scar sonomorphology. Surgery should be offered only to women with symptoms of the Cesarean scar syndrome.

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Conflict of interest statement

Conflict of Interests

None.

Figures

Figure 1
Figure 1
Sagittal plane of the uterus obtained transvaginally 6 weeks after CS. The thickness of the CS scar (1), the thickness of the myometrium proximally (2) and distally (3) to the CS scar.
Figure 2
Figure 2
(A) Intact perimetrium above the isthmocele. (B) Opened perimetrium and prepared CS scar region. (C) The uterine incision was closed with a single layer of running absorbable barbed sutures. (D) Final image of the sutured uterine isthmus.
Figure 3
Figure 3
Laparoscopic image of the intact perimetrium above the ultrasonographically identified isthmocele.
Figure 4
Figure 4
Laparoscopic image. Solid large adhesions of the vesicouterine pouch in a woman with severe CS scar defect.
See this image and copyright information in PMC

References

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