8934 Laparoscopic Isthmocele Repair

Abstract

<h3>Study Objective</h3> The treatment of symptomatic isthmoceles can be medical (with oral contraceptives) in small defects (residual myometrium greater than 3 mm), and by minimal invasion in large defects or those small that did not respond to medical treatment. In defects with residual myometrium > 3 mm, the correction is done by hysteroscopy. The fibrotic tissue of the defect is removed, the edges of the niche are resected, achieving continuity of the uterine wall with the cervical canal, and the base is fulgurated to remove inflamed tissue. In defects with residual myometrium <3 mm, laparoscopic treatment is recommended. The edges are resected to remove scar tissue, and the defect is closed with two-layer sutures. The combination of hysteroscopy-laparoscopy allows transillumination of the defect by hysteroscopy and laparoscopic correction, which also allows the treatment of other causes of pain and infertility, as well as mobilization of the bladder and revision of tubal patency. Surgery improves HUA, chronic pelvic pain, and infertility in 71.4%, 83.3%, and 83.3%, respectively, based on a case series. Hysterectomy is reserved for patients who do not wish to be fertile or who have persistent symptoms after conservative treatment. <h3>Design</h3> Video of hysteroscopy-guided laparoscopic isthmocele correction surgery. Informed consent of the patient. Literature review. <h3>Setting</h3> Proceeding in a pre-scheduled manner, under general anesthesia in the Trendelenburg position, with access to the abdominal cavity under a routinely specified pneumoperitoneum for the consequent inspection of the pelvic abdominal cavity <h3>Patients or Participants</h3> Patients with defects with residual myometrium <3 mm. <h3>Interventions</h3> Laparoscopic correction of isthmocele. <h3>Measurements and Main Results</h3> N/A. <h3>Conclusion</h3> Patients with large isthmoceles with <3mm residual myometrium benefit from hysteroscopy-assisted laparoscopic isthmoplasty.