Isthmocele—a New Obstetric Surgery Sequela for Laparoscopic Surgeons

Abstract

Cesarean section is a common obstetric surgery worldwide. It leads to hitherto unrecognized but not too uncommon sequela known as isthmocele—which is a cesarean section scar defect in the uterus which goes mostly unrecognized and is not cared for. It is certainly not asymptomatic nor totally benign. Such patients suffer from lower abdominal pain, abnormal menstrual bleeding, and secondary infertility including in vitro fertilization (IVF) failure, and they were not responding to a medical treatment. This defect was recognized in a case series of 17 patients and was successfully treated by a laparoscopy repair. Saline-filled hysteroscopy (5 mm) along with an ultrasound examination was the main diagnostic modality. The laparoscopic procedure under general anesthesia included adhesiolysis if any, the lower uterine segment scar excision assisted by transvaginal illumination, and intra-corporeal re-suturing of uterine defect using a number zero polyglycolic acid suture in 2 layers. The post-menstrual bleeding abated in all 17 patients; 6/17 desired a 2nd pregnancy and they are under observation.