Caesarean section greatly increases risk of scar endometriosis.
OBJECTIVE
To estimate the incidence of scar endometriosis after different surgical procedures.


METHODS
A retrospective study of 72 patients diagnosed with scar endometriosis between 1978 and 2003 was performed. Patient age, site of endometriosis, previous operations, time-gap between last surgery and onset of symptoms, nodule characteristics, and recurrence were evaluated.


RESULTS
Age ranged from 16 to 48 years. Location varied according to the previous surgery: 46 caesarean section, one hysterectomy, one in abdominal surgery, 19 episiotomy, one was a relapse and two pelvic floor procedures, two women with no previous surgery. The incidence of scar endometriosis after caesarean section was significantly higher than after episiotomy (0.2 and 0.06%, respectively: p<0.00001) with a relative risk of 3.3. Pain was the most frequent symptom. The mean time between surgery and onset of symptoms was 3.7 years.


CONCLUSIONS
Our findings confirm that scar endometriosis is a rare condition and indicate, probably for the first time, that caesarean section greatly increases the risk of developing scar endometriosis.
Postgraduate Medical School of the Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
Nilo Sérgio
NS
Nominato
Luis Felipe Victor Spyer
LF
Prates
Isabela
I
Lauar
Jaqueline
J
Morais
Laura
L
Maia
Selmo
S
Geber
D000293:Adolescent; D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects* / Q000706:statistics & numerical data; D002921:Cicatrix / Q000453:epidemiology*; D004715:Endometriosis / Q000453:epidemiology*; D004841:Episiotomy / Q000009:adverse effects; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects; D015994:Incidence; D008875:Middle Aged; D011247:Pregnancy; D012189:Retrospective Studies; D055815:Young Adult