Impact of hysteroscopic surgery for isthmocele associated with cesarean scar syndrome.

Abstract

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. 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. All patients underwent surgery without any complications. The residual myometrium was thicker after hysteroscopic surgery (median: 2.1mm and 4.2mm, before and after surgery, respectively; P=0.0001). Isthmocele volume was significantly reduced after hysteroscopic surgery (median: 494.9mm3 and 282.8mm3 , before and after surgery, respectively; P=0.0016). This study demonstrated that hysteroscopic surgery is effective in increasing the residual myometrial thickness and reducing the size of isthmocele.