title: Defect width: the prognostic index for vaginal repair of cesarean section diverticula.
abstract: OBJECTIVE
  To evaluate the clinical parameter associated with cesarean section diverticula anatomic healing via vaginal repair management.
  
  
  METHODS
  Observational cohort study. From Jul 2014 to Dec 2015, 143 women with CSD underwent vaginal repair surgery in Shanghai First Maternity and Infant Hospital, and 137(95.80%) were diagnosed using both transvaginal ultrasound and MRI. A total of 124 patients (86.71%) who were followed-up for more than 6 months after surgery were enrolled in this study. Excision and suture of CSD was performed through the vaginal approach. The defect sizes of the width, length, depth and TRM before or after repair were evaluated.
  
  
  RESULTS
  The mean preoperative duration of menstruation was 14.47 ± 3.30 days and the thickness of the remaining muscular layer was 2.65 ± 1.13 mm before surgery. The study revealed that the healing effects of CSD repair stabilized 3 months after surgery. At the median follow-up time (11.28 months), CSD disappeared after surgery in 64.52% of patients (80/124), and 60.0% of patients (48/80) reached ≤7 days of menstruation. Meanwhile, for 35.48% of patients (44/124), CSD persisted at the median follow-up after surgery, and 31.82% (14/44) of these patients reached ≤7 days of menstruation(P < 0.05). TRM at a median follow-up time after vaginal repair >7.88 mm, 92.11% (70/76) of CSD disappeared. Moreover, when preoperative CSD width ≤18.85 mm indicates that only 18.75% (12/64) of patients will present with CSD after vaginal repair, as determined by MRI (95% CI 0.515-0.737).
  
  
  CONCLUSIONS
  The defect width of the preoperative CSD was the prognostic index of CSD anatomical repair effect. When the preoperative CSD width >18.85 mm, we should pay more attention to the edge of the defect during vaginal repairing.
authors.affiliation: Department of Gynecology, Shanghai First Maternity and Infant Hospital, Affiliated to Tongji University, 2699 Gaoke West Rd, Pudong District, Shanghai, 200036, China.
authors.forename: Xingchen
authors.initials: X
authors.lastname: Zhou
authors.affiliation: Department of Gynecology, Shanghai First Maternity and Infant Hospital, Affiliated to Tongji University, 2699 Gaoke West Rd, Pudong District, Shanghai, 200036, 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, 2699 Gaoke West Rd, Pudong District, Shanghai, 200036, 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, 2699 Gaoke West Rd, Pudong District, Shanghai, 200036, China.
authors.forename: Weilin
authors.initials: W
authors.lastname: Tan
authors.affiliation: Department of Gynecology, Shanghai First Maternity and Infant Hospital, Affiliated to Tongji University, 2699 Gaoke West Rd, Pudong District, Shanghai, 200036, 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, 2699 Gaoke West Rd, Pudong District, Shanghai, 200036, China. xipengwang@hotmail.com.
authors.forename: Xipeng
authors.initials: X
authors.lastname: Wang
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects*; D015331:Cohort Studies; D004240:Diverticulum / Q000601:surgery*; D005260:Female; D013509:Gynecologic Surgical Procedures; D006801:Humans; D008598:Menstruation; D011247:Pregnancy; D011379:Prognosis; D014621:Vagina / Q000601:surgery*; D014945:Wound Healing
keywords: Cesarean section diverticula; Defect width; Thickness of remaining muscular layer; Vaginal repair