Pregnancy outcomes after hysteroscopic surgery in women with cesarean scar syndrome

Tsuji, Shunichiro; Takahashi, Akimasa; Higuchi, Asuka; Yamanaka, Akiyoshi; Amano, Tsukuru; Kimura, Fuminori; Seko-Nitta, Ayumi; Murakami, Takashi

doi:10.1371/journal.pone.0243421

Cited by 23 publications

(20 citation statements)

References 25 publications

(38 reference statements)

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“…Endometriosis was resected in all cases. The infertility rate after surgery was 26% in patients with endometriosis, similar to our results [ 12 ]. Surgical removal of endometriosis improves pregnancy rates [ 18 , 19 , 20 ].…”

Section: Discussionsupporting

confidence: 91%

“…Several studies report the existence of endometriosis in the isthmocele (also called uterine scar endometriosis), but the presence of coexisting extrauterine endometriosis has not yet been reported [ 8 , 9 , 10 , 11 ]. Just one study presents findings concerning extrauterine endometriosis in patients with symptomatic isthmocele [ 12 ]. The present study sheds light on the relationship between isthmocele and endometriosis by investigating two questions: (a) whether endometriosis, both extrauterine endometriosis and uterine scar endometriosis, is a frequent finding in patients with isthmocele and (b) whether both types of endometriosis are correlated.…”

Section: Introductionmentioning

confidence: 99%

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Endometriosis and Isthmocele: Common or Rare?

Gulz

Imboden

Nirgianakis

et al. 2022

JCM

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Higher cesarean section rates and better ultrasound diagnostics have led to a more frequent diagnosis of isthmocele, a cesarean scar defect. Sometimes, endometriosis is found in the isthmocele, but simultaneous extrauterine endometriosis and endometriosis in the isthmocele have not yet been reported. Additionally, the surgical technique to repair the isthmocele is the subject of ongoing controversy. The aim of this study is to analyze a possible correlation between uterine scar (isthmocele) endometriosis and extrauterine endometriosis and to investigate the outcome of laparoscopic isthmocele resection in the rendezvous technique. In this single-center retrospective study, we included 83 women of reproductive age with symptomatic isthmocele undergoing laparoscopic isthmocele repair in rendezvous technique from 2004 to 2020 at the University of Bern. We collected data on patient and surgical characteristics as well as on postoperative outcomes (symptoms, further pregnancy, and pregnancy outcomes) retrospectively. We analyzed and compared these data for patients with and without endometriosis. Endometriosis was diagnosed during surgery in 22 out of 83 operated patients (26.5%). Diagnosis of isthmocele endometriosis (n = 9, 11%) was significantly higher in patients with extrauterine endometriosis (n = 6, p = 0.004). While the duration of surgery was significantly longer for patients with endometriosis (p = 0.006), the groups did not differ with regard to blood loss or complications. In addition, both groups showed similar indications for isthmocele repair (infertility, abnormal uterine bleeding, or dysmenorrhea). Surgery significantly improved abnormal uterine bleeding (χ2 p < 0.001), dysmenorrhea (χ2, p = 0.03), and infertility (χ2, p < 0.001). Regardless of the presence of endometriosis, 25 of 40 (63%) infertile patients became pregnant after surgery. In one out of eight pregnancies, however, we observed scar complications during pregnancy such as uterine scar pregnancy (n = 3), uterine scar dehiscence (n = 3), and placenta previa (n = 1). Endometriosis is a non-negligible intraoperative finding in patients with symptomatic isthmocele. The laparoscopic approach in the rendezvous technique is safe and effective. Therefore, this method should be recommended, especially in women with secondary infertility, and preoperatively simultaneous endometriosis resection should be discussed with the patient. In follow-up, postoperative pregnancies have to be monitored with care.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Endometriosis and Isthmocele: Common or Rare?

Gulz

Imboden

Nirgianakis

et al. 2022

JCM

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“…Similar to our previous report, hysteroscopic findings demonstrated dendric vessels on the CSD surface and the absence of the endometrium. 18 , 19 , 20 In contrast, the endometrium could be observed on the CSD surface in the non‐CSS group. This difference may contribute to infertility in the CSS group; however, the reason for the absence of the endometrium on the CSD surface remains unclear.…”

Section: Discussionmentioning

confidence: 86%

Histopathological evaluation of cesarean scar defect in women with cesarean scar syndrome

Higuchi

Tsuji

Nobuta

et al. 2021

Reprod Medicine & Biology

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Purpose To explore the histopathological findings of cesarean scar defect (CSD) and the immunological component in women with cesarean scar syndrome (CSS). Methods This retrospective study was conducted in a university hospital and a public hospital. A total of 63 patients with secondary infertility due to CSS who underwent laparoscopic resection of the CSD lesion were enrolled (CSS group), and 21 patients who underwent hysterectomy with a history of cesarean section were enrolled as control (non‐CSS group). We compared the differences in histopathological findings of CSD lesions by hematoxylin and eosin staining and immunohistochemistry for CD3, CD20, CD56, CD68, CD138, myeloperoxidase, and tryptase between the two groups. Results The frequency of presence of endometrium on the CSD surface was significantly lower ( p = 0.0023) and that of adenomyosis was significantly higher ( p = 0.0195) in the CSS group than in the non‐CSS group. The number of CD3‐, CD20‐, CD68‐, and tryptase‐positive cells was significantly lower in the CSS group than in the non‐CSS group; however, the number of CD138‐positive cells was significantly higher in the CSS group ( p = 0.0042). Conclusions This study suggested that the absence of endometrium, presence of adenomyosis, and chronic inflammation in CSD contributes to secondary infertility due to CSS.

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“…None of the studies included a combination of women with and without infertility. An overview of the baseline characteristics, including niche features, is reported for the studies that included women diagnosed with infertility (Table 1) (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35) and women without infertility (Table 2) (36)(37)(38)(39)(40). Most studies evaluated HNR (N ¼ 14), and 7, 7, and 2 studies reported on VNR, LSNR, and LTNR, respectively.…”

Section: Study and Population Characteristicsmentioning

confidence: 99%