Abstract
We read with interest the letter by Demers et al [ 1 Demers S. Roberge S. Bujold M. Laparoscopic repair of post-cesarean uterine scar defect [letter]. J Minim Invasive Gynecol. 2013; 20: 536-537 Abstract Full Text Full Text PDF Scopus (12) Google Scholar ] concerning our recent publication on laparoscopic repair of post-cesarean section uterine scar defects in non-pregnant women [ 2 Marotta M.L. Donnez J. Squifflet J. Jadoul P. Darii N. Donnez O. Laparoscopic repair of post-cesarean section uterine scar defects diagnosed in non-pregnant women. J Minim Invasive Gynecol. 2013; 20: 386-391 Abstract Full Text Full Text PDF PubMed Scopus (96) Google Scholar ]. The authors seem to be skeptical about the grounds that led to performance of this surgery. First, symptoms such as pain, dysmenorrhea, postmenstrual bleeding, infertility, and even uterine scar dehiscence or rupture have been well described in the literature [ 3 Vikhareva Osser O. Valentin L. Clinical importance of appearance of caesarean hysterotomy scar at transvaginal ultrasonography in nonpregnant women. Obstet Gynecol. 2011; 117: 525-532 Crossref PubMed Scopus (113) Google Scholar , 4 Roberge S. Boutin A. Chaillet N. et al. Systematic review of cesarean scar assessment in the nonpregnant state: imaging techniques and uterine scar defect. Am J Perinatol. 2012; 29: 465-471 Crossref PubMed Scopus (93) Google Scholar , 5 Thurmond A.S. Harvey W.J. Smith S.A. Cesarean section scar as a cause of abnormal vaginal bleeding: diagnosis by sonohysterography. J Ultrasound Med. 1999; 18: 13-16 PubMed Google Scholar , 6 Gubbini G. Centini G. Nascetti D. et al. Surgical hysteroscopic treatment of cesarean-induced isthmocele in restoring fertility: prospective study. J Minim Invasive Gynecol. 2011; 18: 234-237 Abstract Full Text Full Text PDF PubMed Scopus (115) Google Scholar , 7 Florio P. Filippeschi M. Moncini I. Marra E. Franchini M. Gubbini G. Hysteroscopic treatment of the cesarean-induced isthmocele in restoring infertility. Curr Opin Obstet Gynecol. 2012; 24: 180-186 Crossref PubMed Scopus (62) Google Scholar ]. It was clearly mentioned in our paper that 69.2% of our patients experienced symptoms. Moreover, two studies have clearly identified large defects as risk factors for uterine rupture, with odds ratios of 11.8 and 26.5 [ 3 Vikhareva Osser O. Valentin L. Clinical importance of appearance of caesarean hysterotomy scar at transvaginal ultrasonography in nonpregnant women. Obstet Gynecol. 2011; 117: 525-532 Crossref PubMed Scopus (113) Google Scholar , 4 Roberge S. Boutin A. Chaillet N. et al. Systematic review of cesarean scar assessment in the nonpregnant state: imaging techniques and uterine scar defect. Am J Perinatol. 2012; 29: 465-471 Crossref PubMed Scopus (93) Google Scholar ], and it has also been reported by Roberge et al [ 4 Roberge S. Boutin A. Chaillet N. et al. Systematic review of cesarean scar assessment in the nonpregnant state: imaging techniques and uterine scar defect. Am J Perinatol. 2012; 29: 465-471 Crossref PubMed Scopus (93) Google Scholar ]. Our results manifestly demonstrated that patients who had symptoms before surgery were free of symptoms after surgery and that pregnancy could be achieved without any serious adverse effects. The benefits of this surgery therefore seem evident to us. Laparoscopic Repair of Post-Cesarean Uterine Scar DefectJournal of Minimally Invasive GynecologyVol. 20Issue 4PreviewWe read with interest the article by Marotta et al [1]. who reported repair of 13 uterine scar defects. However, we are skeptical as to what led to these surgical procedures. We do not understand why these women gave consent and what the expected benefits were. We are concerned that misunderstanding of our previous publications could have misled the authors. Full-Text PDF
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