Laparoscopic Isthmocele Repair: Efficacy and Benefits before and after Subsequent Cesarean Section.

Stavros Karampelas,Laurent De Landsheere,Michelle Nisolle,Linda Tebache,Georges Salem Wehbe,Dominique A Badr

doi:10.3390/jcm10245785

Abstract

Objective: To evaluate the effect of laparoscopic isthmocele repair on isthmocele-related symptoms and/or fertility-related problems. The residual myometrial thickness before and after subsequent cesarean section was also evaluated. Design: Retrospective, case series. Setting: Public university hospital. Population: Women with isthmocele (residual myometrium < 5 mm) complaining of abnormal uterine bleeding, chronic pelvic pain or secondary infertility not otherwise specified. Methods: Women’s complaints and the residual myometrium were assessed pre-operatively and at three to six months post-operatively. In patients who conceived after surgery, the latter was measured at least six months after delivery by cesarean section. Main Outcome Measures: Resolution of the main symptom three to six months after surgery and persistence of laparoscopic repair benefits after subsequent cesarean section were considered as primary outcome measures. Results: Overall, 31 women underwent laparoscopic isthmocele repair. The success rates of the surgery as improvement of abnormal uterine bleeding, chronic pelvic pain and secondary infertility were 71.4% (10 of 14), 83.3% (10 of 12) and 83.3% (10 of 12), respectively. Mean residual myometrial thickness increased significantly from 1.77 mm pre-operatively to 6.67 mm, three to six months post-operatively. Mean myometrial thickness in patients who underwent subsequent cesarean section (N = 7) was 4.49 mm. In this sub-group, there was no significant difference between the mean myometrial thickness measured after the laparoscopic isthmocele repair and that measured after the subsequent cesarean section. None of these patients reported recurrence of their symptoms after delivery. Conclusion: Our findings suggest that the laparoscopic isthmocele excision and repair is an appropriate approach for the treatment of isthmocele-related symptoms when done by skilled laparoscopic surgeons. The benefit of this new surgical approach seems to persist even after a subsequent cesarean section. Further investigations and prospective studies are required to confirm this finding.

Highlights

The study was approved by the Hospital’s Ethics Committee under the reference number B412201836328. It included women with a history of at least one cesarean section (CS), who agreed to undergo a laparoscopic repair of their symptomatic isthmocele with a residual myometrial (RM) < 5 mm
After removal of the pregnancy followed by the immediate repair of the defect, the patients reported resolution of their isthmocele-related symptoms
We found high success rates of laparoscopic isthmocele excision and repair for the treatment of isthmocele-related symptoms (AUB, chronic pelvic pain (CPP) and SI)

Summary

Introduction

Licensee MDPI, Basel, Switzerland.Attribution (CC BY) license (https://creativecommons.org/licenses/by/Over recent decades, delivery by cesarean section (CS) has become increasingly common in both developed and developing countries. Nowadays, the percentage of CS delivery is well above the ideal rate recommended by the World Health Organization (WHO) [1,2].In addition to short-term risks of CS, there are long-term risks several years after the current delivery that can affect women’s health and their future pregnancy outcomes [3].The complications and consequences of CS are also increasing in number. Abnormal placentation and placenta previa have already been established and studied [4,5]. However, 4.0/).

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