title: Vaginal Repair of Cesarean Section Scar Diverticula that Resulted in Improved Postoperative Menstruation.
abstract: Owing to the increase in cesarean sections (C-sections) worldwide, long-term complications such as postmenstrual spotting, chronic pelvic pain, and C-section scar ectopic pregnancies have created a new medical era of gynecologic disease. A new type of vaginal repair is evaluated to repair C-section diverticulum (CSD) and rebuild the muscular layer to improve symptoms of abnormal uterine bleeding and decrease the risk of uterine rupture.
  
  
  
  Retrospective cohort study (Canadian Task Force classification II-2).
  
  
  
  University hospital.
  
  
  
  A total of 121 patients with CSD diagnoses by transvaginal ultrasound (TVU) presented with postmenstrual spotting between June 2012 and March 2015. All patients had undergone at least 1 C-section delivery and had no history of postmenstrual spotting before undergoing C-section.
  
  
  
  Vaginal excision and suture of CSD.
  
  
  
  The mean duration of menstruation was 14.87 ± 3.46 days preoperatively and decreased to 8.22 ± 2.73 days at 1 month after surgery, 8.89 ± 2.67 days at 3 months after surgery, and 9.02 ± 2.47 days at 6 months after surgery (p < .01). The length, width, depth, and thickness of the remaining muscular layer (TRM) at 1 month, 3 months, and 6 months assessed by TVU also improved significantly after surgery (p < .05). However, postoperative menstruation and imaging data did not differ markedly between 3 months and 6 months, suggesting that follow-up at 3 months represents an adequate endpoint for evaluating the effectiveness of surgery. At 6 months, 80.3% of patients (94 of 117) reached ≤10 days of menstruation. Further study revealed that a TRM at 6 months of ≥8.5 mm measured by TVU (relative risk [RR], 6.418; 95% confidence interval [CI], 1.478-28.443) and an interval between CS and vaginal repair of ≤2.5 years (RR, 12.0; 95% CI, 1.541- 93.454) were good prognostic factors associated with surgery.
  
  
  
  Vaginal repair of CSD improved the symptoms of postmenstrual spotting and anatomically corrected the scars. An interval between C-section and a surgery of ≤2.5 years was optimal for vaginal repair, and a TRM at 6 months of ≥8.5 mm represented the standard healing of CSD.
authors.affiliation: Department of Gynecology, Shanghai First Maternity and Infant Hospital, Affiliated to Tongji University, Shanghai, China.
authors.forename: Jieru
authors.initials: J
authors.lastname: Zhou
authors.affiliation: Department of Gynecology, Shanghai First Maternity and Infant Hospital, Affiliated to Tongji University, Shanghai, China.
authors.forename: Min
authors.initials: M
authors.lastname: Yao
authors.affiliation: Department of Gynecology, Shanghai First Maternity and Infant Hospital, Affiliated to Tongji University, Shanghai, China.
authors.forename: Husheng
authors.initials: H
authors.lastname: Wang
authors.affiliation: Department of Gynecology, Shanghai First Maternity and Infant Hospital, Affiliated to Tongji University, Shanghai, China.
authors.forename: Weilin
authors.initials: W
authors.lastname: Tan
authors.affiliation: Department of Ultrasonography, Shanghai First Maternity and Infant Hospital, Affiliated to Tongji University, Shanghai, China.
authors.forename: Pin
authors.initials: P
authors.lastname: Chen
authors.affiliation: Department of Gynecology, Shanghai First Maternity and Infant Hospital, Affiliated to Tongji University, Shanghai, China. Electronic address: xipengwang@hotmail.com.
authors.forename: Xipeng
authors.initials: X
authors.lastname: Wang
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects*; D002921:Cicatrix / Q000150:complications / Q000601:surgery; D004240:Diverticulum / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D006801:Humans; D008598:Menstruation; D008796:Metrorrhagia / Q000209:etiology*; D017699:Pelvic Pain; D011247:Pregnancy; D012189:Retrospective Studies; D014463:Ultrasonography; D014597:Uterine Rupture / Q000517:prevention & control; D014621:Vagina / Q000601:surgery*; D014623:Vaginal Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D014945:Wound Healing
keywords: Abnormal uterine bleeding; Cesarean section; Cesarean section scar defect; Vaginal surgery