title: New diagnostic criteria and operative strategy for cesarean scar syndrome: Endoscopic repair for secondary infertility caused by cesarean scar defect.
abstract: OBJECTIVE
  The aim of the present study was to assess the efficacy of endoscopic repair for secondary infertility caused by post-cesarean scar defect (PCSD). Our investigation focused on the validity of new diagnostic criteria and selection methods.
  
  
  METHODS
  The subjects were 22 women with secondary infertility due to PCSD with retention of bloody fluid in the uterine cavity. Women with a residual myometrial thickness of ≥ 2.5 mm and an anteflexed or straight uterus underwent hysteroscopic surgery, while all others underwent laparoscopic repair. Hysteroscopic surgery involved resection and coagulation of scarred areas, whereas laparoscopic surgery involved removal of scarred areas combined with hysteroscopy, followed by resuturing.
  
  
  RESULTS
  Fourteen of the 22 women (63.6%) who were followed up for ≥ 1 year after surgery achieved pregnancy. Pregnancies occurred in all four women (100%) who underwent hysteroscopic surgery and in 10 of the 18 women (55.6%) who underwent laparoscopic surgery. Three out of four women who underwent hysteroscopic surgery had term deliveries. Among the women who underwent laparoscopic surgery, five had term deliveries. No cases of uterine rupture were experienced, and the delivery method was cesarean section in all cases.
  
  
  CONCLUSIONS
  We propose that infertility associated with PCSD, cesarean scar syndrome, is caused by the retention of bloody fluid in the uterine cavity and scarring. Endoscopic treatment, such as hysteroscopy or laparoscopy, was effective for cesarean scar syndrome.
authors.affiliation: Department of Obstetrics and Gynecology, Toyama Central Prefectural Hospital, Toyama, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Tanimura
authors.affiliation: Department of Obstetrics and Gynecology, Toyama Central Prefectural Hospital, Toyama, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Funamoto
authors.affiliation: Department of Obstetrics and Gynecology, Toyama Central Prefectural Hospital, Toyama, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Hosono
authors.affiliation: Department of Obstetrics and Gynecology, Toyama Central Prefectural Hospital, Toyama, Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Shitano
authors.affiliation: Department of Obstetrics and Gynecology, Toyama Central Prefectural Hospital, Toyama, Japan.
authors.forename: Masao
authors.initials: M
authors.lastname: Nakashima
authors.affiliation: Department of Obstetrics and Gynecology, Toyama Central Prefectural Hospital, Toyama, Japan.
authors.forename: Yuka
authors.initials: Y
authors.lastname: Ametani
authors.affiliation: Department of Obstetrics and Gynecology, Toyama Central Prefectural Hospital, Toyama, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Nakano
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects*; D002921:Cicatrix / Q000150:complications / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D015907:Hysteroscopy; D007247:Infertility, Female / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D010535:Laparoscopy; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000209:etiology / Q000473:pathology / Q000601:surgery; D016896:Treatment Outcome; D014945:Wound Healing
keywords: cesarean scar syndrome; cesarean section; endoscopic repair; infertility; post cesarean scar defect