Impact of hysteroscopic surgery for isthmocele associated with cesarean scar syndrome

Aim Cesarean scar syndrome (CSS) is characterized by increased risk of postmenstrual abnormal uterine bleeding, dysmenorrhea, and infertility, due to a post‐cesarean scar defect known as an isthmocele. This study aimed to assess the impact of hysteroscopic surgery on isthmocele associated with CSS....

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Published in:	The journal of obstetrics and gynaecology research Vol. 44; no. 1; pp. 43 - 48
Main Authors:	Tsuji, Shunichiro, Kimura, Fuminori, Yamanaka, Akiyoshi, Hanada, Tetsuro, Hirata, Kimiko, Takebayashi, Akie, Takashima, Akiko, Seko‐Nitta, Ayumi, Murakami, Takashi
Format:	Journal Article
Language:	English
Published:	Australia Wiley Subscription Services, Inc 01-01-2018
Subjects:	Adult Cautery - methods cesarean scar syndrome Cesarean Section - adverse effects Cicatrix - etiology Cicatrix - surgery Female Humans Hysterectomy hysteroscopic surgery hysteroscopy Hysteroscopy - methods Infertility isthmocele Magnetic resonance imaging Myometrium Myometrium - pathology Outcome Assessment (Health Care) Surgery Syndrome Uterine Diseases - etiology Uterine Diseases - surgery Uterus cesarean scar syndrome isthmocele hysteroscopic surgery infertility hysteroscopy
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Summary:	Aim Cesarean scar syndrome (CSS) is characterized by increased risk of postmenstrual abnormal uterine bleeding, dysmenorrhea, and infertility, due to a post‐cesarean scar defect known as an isthmocele. This study aimed to assess the impact of hysteroscopic surgery on isthmocele associated with CSS. Methods Eighteen patients with CSS were enrolled. Surgical methods included resection of the inferior edge and superficial cauterization of the isthmocele via hysteroscopic surgery. We evaluated the residual myometrial thickness and isthmocele volume using magnetic resonance imaging, before and after hysteroscopic surgery. Results All patients underwent surgery without any complications. The residual myometrium was thicker after hysteroscopic surgery (median: 2.1 mm and 4.2 mm, before and after surgery, respectively; P = 0.0001). Isthmocele volume was significantly reduced after hysteroscopic surgery (median: 494.9 mm3 and 282.8 mm3, before and after surgery, respectively; P = 0.0016). Conclusion This study demonstrated that hysteroscopic surgery is effective in increasing the residual myometrial thickness and reducing the size of isthmocele.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1341-8076 1447-0756
DOI:	10.1111/jog.13464