Laparoscopic correction of the uterine muscle loss in the scar after a Caesarean section delivery.

Abstract

Caesarean section is the most frequently conducted surgery in modern obstetrics. It involves a significant risk of complications; also disorders in the area of the scar after hysterotomy may lead to menstrual disorders, pain and secondary infertility. In light of the presented facts the significance of a good uterus muscle correction method is high. We present a case of a 28-year-old patient after Caesarean section with further reproductive plans. In the ultrasonographic examination the residual thickness of the uterine wall was approx. 2.5–3 mm. The patient was operated on using laparoscopy and the fibrotic scar tissue was removed. During the follow-up examination in transvaginal ultrasonography the uterine muscularis was continuous on the whole surface. Laparoscopic treatment ensures the appropriate visibility which makes the risk of damage to the adjacent organs lower, and the time of convalescence is short. It provides repetitive good results from the anatomical and functional points of view.

The effect of laparoscopic resection of large niches in the uterine caesarean scar on symptoms, ultrasound findings and quality of life: a prospective cohort study

“…Several case reports, case series and small prospective cohort studies with a maximum of 38 included women and one larger retrospective comparative study ( n  = 59) have been reported 5, 12, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35. Eleven articles (including a total of 65 women) reported a reduction or complete resolution of postmenstrual spotting; however, this was mostly not measured in a standardised way 5, 16, 18, 20, 21, 24, 26, 27, 29.…”

Laparoscopic isthmocele treatment - single center experience.

“…There is a lack of consensus about the best treatment choice. In our opinion, in postmenstrual bleeding disorders, when family planning is not yet concluded, surgical correction should generally be the first-line option [ 4 , 12 , 31 – 33 , 47 ]. The hysteroscopic isthmocele excision can only be planned when the patient does not plan further pregnancies [ 9 , 48 ].…”

“…There are excellent reviews about all treatment methods, but there is still a lack of universal guidelines how to proceed with patients suffering from isthmocele [ 30 ]. There are no universal clinical guidelines to indicate which techniques should be preferred, or which of them gave better results in abnormal uterine bleeding, pelvic pain or secondary infertility treatment [ 4 , 30 – 33 ]. Almost every center uses its own indications and methods, but this does not affect overall improvement of therapy.…”

Opciones terapéuticas para el defecto de cicatriz uterina

“…Algunas de las desventajas son los mayores costos, mayor tiempo operatorio, mayor pérdida sanguínea y mayor tiempo de estancia hospitalaria. Por otra parte, las ventajas descritas son la posibilidad de utilizarlo en defectos muy profundos y la posibilidad de tratar defectos que tengan una localización alta, mejor visualización del defecto, menor riesgo de daño a órgano vecino y una corta estancia hospitalaria 16,33 .…”