Novel laparoscopic surgery for the repair of cesarean scar defect without processing scar resection

Abstract

Background Cesarean scar defect (CSD), especially CSD with residual myometrium less than 3 mm is reported to be the highest risk agent associated with uterine rupture for subsequent pregnancy. Currently, laparoscopic resection and suture was the mainstay therapy method for CSD with a residual myometrium less than 3 mm in women with a desire to conceive. Besides, the women have CSD related symptoms, especially postmenstrual bleeding, should be recommended for CSD treatment. This study is to investigate the efficiency of this novel laparoscopic surgery for the repair of cesarean scar defect (CSD) without scar resection for residual myometrium thickening. Method This retrospective clinical study enrolled 76 women diagnosed with CSD who had a residual myometrium thickness less than 3 mm and also had a desire to conceive, had undergone laparoscopic surgery for the repair of CSD in the time period March 2016 to March 2018. Two study cohorts were created among the 76 patients: 40 patients had undergone the novel laparoscopic repair of CSD without processing scar resection (Group A), whereas 36 patients had undergone the traditional laparoscopic resection and suture of CSD (Group B). Results Residual myometrium thickening occurred among all the 76 patients and the average residual myometrium thickness was increased to almost 6 mm, presenting no between-group difference. In Group A, all the CSD-related postmenstrual bleeding was resolved or improved, but one patient in Group B has no obvious change to postmenstrual bleeding. After CSD repair, 20 patients got pregnant naturally in Group A, and there was no cesarean scar pregnancy and uterine rupture. While, there were 9 cases of natural pregnancy in Group B. No uterine rupture occurred among these 9 pregnant women of Group B, but 1 case of pregnancy was terminated due to cesarean scar pregnancy. Conclusion Laparoscopic repair without processing scar resection seems to be a feasible, safe and simple operative approach for CSD treatment, which can thicken residual myometrium and improve postmenstrual bleeding.

Animal models of the placenta accreta spectrum: current status and further perspectives

“…The relative risk of PAS was 8.8 (95% CI: 6.1–12.6) for previous CS, 6.6 (95% CI: 4.4–9.8) for a single CS, 7.4 (95% CI: 4.4–9.8) for two CS, and 55.9 (95% CI: 25.0–110.3) for a history of three or more CS ( 45 ). The process of uterine tissue repair after CS is often accompanied by decreasing endometrial glands, inhibition of myometrial smooth muscle cell growth, excessive collagen fiber deposition, and massive leukocyte infiltration, which leads to long-term and chronic inflammation and scarring ( 63 ). There appears to be preferential attachment of the blastocyst to the scar site, which may be associated with defective decidua in that region, resulting in abnormal implantation ( 64 ).…”

Prevalence, definition, and etiology of cesarean scar defect and treatment of cesarean scar disorder: A narrative review

“…The second point is how to suture the uterine myometrium after resection. Several authors performed double‐layer sutures, 53,65,71,74,75,78,82,85,90,94 whereas several authors performed single‐layer sutures 76,79–81,89,91,95 . So far, no papers compare the superiority of single‐layer and double‐layer sutures for CSD repair.…”

“…Zhang et al demonstrated that the surface of the uterine serosa was condensed by vertical suturing without CSD removal 88 . Zhang et al 91 also demonstrated that laparoscopic repair without scar resection is feasible, safe, and effective for AUB by comparing resection procedures. Peng et al 92 demonstrated that both folding and muscle flap filling suture techniques are effective and safe in women with CSDi.…”

“…However, most authors have detected CSD using hysteroscopic guidance. 56,65,71,[78][79][80]82,[88][89][90][91][92] Nirgianakis K et al 79 named the see-through light from CSD by hysteroscopy as the Halloween sign, and called a combination of laparoscopy and hysteroscopy in the repair for CSD, the Rendezvous technique.…”

“…single-layer sutures. 76,[79][80][81]89,91,95 So far, no papers compare the superiority of single-layer and double-layer sutures for CSD repair.…”