A comparison of vaginal surgery and operative hysteroscopy for the treatment of cesarean-induced isthmocele: a retrospective review.
OBJECTIVE
Cesarean-induced isthmocele can cause heavy or prolonged menses, dyspareunia, and dysmenorrhea. We compared the efficacy of vaginal surgery and operative hysteroscopy for the treatment of cesarean-induced isthmocele.


METHODS
Seventy-seven women with cesarean-induced isthmocele underwent either vaginal surgery or operative hysteroscopy between August 2008 and December 2011. We evaluated operating time, blood loss, complications, and postoperative pregnancy. Operative efficacy was defined as an improvement in menstrual periods and a change in residual isthmocele nidus size on transvaginal ultrasonography.


RESULTS
The operative efficacy of vaginal surgery was superior to that of hysteroscopy (93.5 vs. 64.5%; p < 0.001). However, patients who underwent vaginal surgery had a longer operative time (55 vs. 25 min; p < 0.001) and greater blood loss (50 vs. 10 ml; p < 0.001). Two patients in each group were able to achieve subsequent pregnancy. Patients who had menstrual periods longer than 7 days after surgery were more likely to have a residual nidus.


CONCLUSIONS
The therapeutic efficacy of vaginal surgery is superior to operative hysteroscopy in the treatment of cesarean-induced isthmocele.
Department of Gynecology and Obstetrics, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
Hongzhe
H
Xie
Yanxin
Y
Wu
Fan
F
Yu
Mian
M
He
Minghui
M
Cao
Shuzhong
S
Yao
D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects / Q000379:methods* / Q000592:standards; D006801:Humans; D015907:Hysteroscopy / Q000009:adverse effects / Q000379:methods* / Q000592:standards; D008597:Menstrual Cycle / Q000502:physiology; D011183:Postoperative Complications / Q000601:surgery*; D011184:Postoperative Period; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014599:Uterus / Q000473:pathology / Q000601:surgery*; D014621:Vagina