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. 2023 May 28;12(11):3720.
doi: 10.3390/jcm12113720.

Outcomes of Laparoscopic Cesarean Scar Defect Repair: Retrospective and Observational Study

Camran Nezhat  1   2   3 , Benjamin Zaghi  1 , Kelly Baek  4 , Azadeh Nezhat  1   2   3 , Farr Nezhat  5   6   7 , Steven Lindheim  8   9 , Ceana Nezhat  10
Affiliations

Outcomes of Laparoscopic Cesarean Scar Defect Repair: Retrospective and Observational Study

Camran Nezhat et al. J Clin Med. .

Abstract

Cesarean scar defect, also known as niche, isthmocele, uteroperitoneal fistula and uterine diverticulum, is a known complication after cesarean delivery. Due to the rising cesarean delivery rates, niche has become more common and can present as irregular bleeding, pelvic pain, infertility, cesarean scar pregnancy and uterine rupture. Treatments for symptomatic cesarean scar defect vary and include hormonal therapy, hysteroscopic resection, vaginal or laparoscopic repair, and hysterectomy. We report on the safety and efficacy of our method of repairing cesarean scar defects in 27 patients without adverse outcomes: two-layer repair where the suture does not enter the uterine cavity. Our method of laparoscopic niche repair improves symptoms in nearly 77% of patients, restores fertility in 73% of patients, and decreases the time to conception.

Keywords: cesarean scar defect; isthmocele; niche; pregnancy; uterine diverticulum; uteroperitoneal fistula.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Transvaginal ultrasound can be used for in-office diagnosis. Ultrasound courtesy of Antony Dobson, MD, PhD.
Figure 2
Figure 2
A hysteroscopic view of a niche. Notice the outpouching into the anterior lower uterine segment.
Figure 3
Figure 3
This picture demonstrates dense adhesions between the uterus, rectus muscle, and bladder because the peritoneum was not closed during cesarean delivery. This can lead to more difficult niche repair and hysterectomy.
See this image and copyright information in PMC

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