Endoscopic surgical treatment of isthmocele and it’s probale link with endometriosis. A 3-years retrospective review of combined laparoscopic and hysteroscopic surgery

Abstract

The aim, is to share our experience on the efficacy of combined laparoscopic and hysteroscopic surgical treatment of isthmocele, and the possible link with endometriosis. 28 patients with isthmocele, who underwent combined laparoscopic and hysteroscopic repair were retrospectively analysed. Presenting symptoms were; bleeding disorder, infertility, lower abdominal pain, dysmenorrhea and chronic vaginal discharge. All noticeable changes observed in the preoperative symptoms, were evaluated at 1, 3, and 6 months postoperatively, while fertility return within the first 24 months postoperatively was also evaluated. Average age of the patients was 36.9±4.5, fertility return after surgery was 82.4% (n=14/17), post menstrual bleeding disorders was almost completely resolved in all the patients in the 1, 3, and 6 months after surgery, mean bleeding duration was significantly shorter than the preoperative period 3.6±1.1 days as against 10.3±1.7days. There was significant resolution of the other symptoms like dysmenorrhea, chronic vaginal discharge and suprapubic pain at 6 months after surgery. Endometriosis was found in 16 (57.1%) patients, which is remarkably high in patients who had no previous history or diagnosis of endometriosis. The overall patient satisfaction rate was 92.9% (26/28). Our experience shows that, the combined used of hysteroscopy and laparoscopy is very effective in the management of isthmocele with minimal complications. Our findings also suggests a possible link between endometriosis and isthmocele. Further large scale studies may be required to ascertain these findings. Keywords: Endometriosis, Pelvic pain, Dysmenorrhea, Premenstrual syndrome, Abnormal uterine bleeding, Laparoscopy, Hysteroscopy, Caesarean section, Isthmocele.