title: Laparoscopic and vaginal repair of uterine scar dehiscence following cesarean section as detected by ultrasound.
abstract: OBJECTIVE
  Cesarean section (CS) is the most common operation in obstetrics, with rising incidence in most countries. As a result of this operation late scar dehiscence may occur, which may lead to uterine rupture in a subsequent pregnancy. In this case series we have described sonographic detection of scar dehiscence after CS and feasibility of vaginal or combined laparoscopic and vaginal scar excision and uterine repair.
  
  
  METHODS
  Five consecutive patients underwent vaginal or laparoscopic assisted vaginal approach for repair of suspected scar dehiscence following CS, during a 5 year period. In all cases, transvaginal sonography detected suspicious features of scar dehiscence over the anterior uterine wall. Except of one, all patients had reported recurrent pelvic pain and/or irregular menstrual bleedings. Furthermore all patients planned for a further pregnancy.
  
  
  RESULTS
  Resection of the uterine defect and re-constitution of the uterine wall was successfully achieved in all five patients. There were no intra-operative complications and none of the patients required blood transfusion. The mean operation time was 117 min (27-192). Presence of scar tissue was confirmed on histology in all specimens. Four patients remained free of symptoms with no evidence of recurrent scar dehiscence on sonography over a median follow up of 30 months (3-46). One patient had an uneventful pregnancy 24 months after scar removal and was delivered by repeat CS at 39 weeks' gestation.
  
  
  CONCLUSIONS
  Patients with a history of CS should undergo transvaginal sonography of the scar region in order to detect latent scar dehiscence in combination with uterine wall thinning prior to planning further pregnancy. In suspected cases, a combined laparoscopic - vaginal or vaginal approach can be employed to repair the defect.
authors.affiliation: Department of Gynecology, Friedrich-Schiller-University Jena, Germany.
authors.forename: Petra
authors.initials: P
authors.lastname: Klemm
authors.forename: Christhardt
authors.initials: C
authors.lastname: Koehler
authors.forename: Mandy
authors.initials: M
authors.lastname: Mangler
authors.forename: Uwe
authors.initials: U
authors.lastname: Schneider
authors.forename: Achim
authors.initials: A
authors.lastname: Schneider
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects*; D002921:Cicatrix / Q000000981:diagnostic imaging / Q000601:surgery; D005260:Female; D006801:Humans; D007813:Laparotomy / Q000379:methods; D013529:Surgical Wound Dehiscence / Q000000981:diagnostic imaging / Q000601:surgery*; D014463:Ultrasonography; D014597:Uterine Rupture / Q000517:prevention & control; D014599:Uterus / Q000000981:diagnostic imaging / Q000601:surgery*