Outcomes of Endoscopic Cesarean Scar Defect Repair—A Retrospective Observational Study [22B

Abstract

INTRODUCTION: Cesarean scar defects may cause abnormal uterine bleeding, pelvic pain and infertility. We present our preliminary results after laparoscopic and/or hysteroscopic surgical repair. METHODS: We performed a retrospective review of clinical data and preliminary outcomes of patients with cesarean scar defect who underwent surgery at the Camran Nezhat Institute. RESULTS: We included a total of 27 women. Average age was 36 years, with an average BMI of 23.1 kg/m2. Most patients (74%) had 1 prior cesarean section, while 26% had 2 or more. The most common presenting symptom was pelvic pain (81%), followed by dysmenorrhea (70%), irregular vaginal bleeding (67%) and infertility (48%). Nearly half (44%) of the patients had a previous diagnosis of endometriosis. Prior to presenting to our center, 52% of patients with infertility had attempted IVF, and 30% attempted IUI. Defect repair was performed by a combined laparoscopic and hysteroscopic approach in 85% of patients, while 7% underwent hysteroscopic repair and 11% a hysterectomy. There were 2 postoperative complications, namely umbilical scar revision and umbilical cellulitis. A diagnosis of endometriosis was established by pathology in 67% of cases. Symptoms resolved in 33% of patients, improved in 44%, and persisted in 18%. In those who desired future fertility, the clinical pregnancy rate after repair was 47% (n=7), with five resulting in live births (33%) and two miscarriages (7%). CONCLUSION: Cesarean scar defect repair proved beneficial with improved symptoms in 77% of patients and restored fertility in 47%. Lower pregnancy rates may be related to the increased prevalence of endometriosis in this sample.