title: Should Cesarean Scar Defect Be Treated Laparoscopically? A Case Report and Review of the Literature.
abstract: Several obstetric complications due to inappropriately healed cesarean scar such as placenta accreta, scar dehiscence, and ectopic scar pregnancy are increasingly reported along with rising cesarean rates. Furthermore, many gynecologic conditions, including abnormal uterine bleeding, pelvic pain and infertility, are imputed to deficient cesarean scar healing. Hysteroscopy is the most commonly reported approach for the revision of cesarean scar defects (CSDs). Nevertheless, existing evidence is inadequate to conclude that either hysteroscopy or laparoscopy is effective or superior to each other. Although several management options have been suggested recently, the laparoscopic approach has not been thoroughly scrutinized. We present a case and reviewed the data related to the laparoscopic repair of CSDs and compared the hysteroscopic and laparoscopic management options based on the data from previously published articles. As a result of our analyses, the laparoscopic approach increases uterine wall thickness when compared with the hysteroscopic approach, and both surgical techniques seem to be effective for the resolution of gynecologic symptoms. Hysteroscopic treatment most likely corrects the scar defect but does not strengthen the uterine wall; thus, the potential risk of dehiscence or rupture in subsequent pregnancies does not seem to be improved. Because large uterine defects are known risk factors for scar dehiscence, the repair of the defect to reinforce the myometrial endurance seems to be an appropriate method of treatment.
authors.affiliation: Department of Obstetrics and Gynecology, Zeynep Kamil Women and Children Diseases Training and Research Hospital, Istanbul, Turkey.
authors.forename: Murat
authors.initials: M
authors.lastname: Api
authors.affiliation: Goztepe Training and Research Hospital, Istanbul, Turkey. Electronic address: aysenboza@hotmail.com.
authors.forename: Aysen
authors.initials: A
authors.lastname: Boza
authors.affiliation: Acibadem Hospital, Istanbul, Turkey.
authors.forename: Husnu
authors.initials: H
authors.lastname: Gorgen
authors.affiliation: Yeditepe University School of Medicine, Istanbul, Turkey.
authors.forename: Olus
authors.initials: O
authors.lastname: Api
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects*; D002921:Cicatrix / Q000150:complications* / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D017699:Pelvic Pain / Q000209:etiology*; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000473:pathology / Q000601:surgery*; D012086:Reoperation; D014591:Uterine Diseases / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D014945:Wound Healing
keywords: Abnormal uterine bleeding; Cesarean scar; Hysteroscopy; Isthmocele; Laparoscopy; Myometrium