Gynecological and obstetrical outcomes after laparoscopic repair of a cesarean scar defect in a series of 38 women

Laparoscopic repair of cesarean scar defects with a residual myometrial thickness of less than 3mmis an appropriate approach.

Like Comment

Volume 107, Issue 1, Pages 289-296


Olivier Donnez, M.D., Ph.D., Jacques Donnez, M.D., Ph.D., Renan Orellana, Ph.D., Marie-Madeleine Dolmans, M.D., Ph.D.



To evaluate gynecological and obstetrical outcomes, as well as remaining myometrial thickness, after laparoscopic repair of a cesarean scar.


Observational study and prospective evaluation of the remaining myometrium before and after repair.


Academic department in a university hospital.


A series of 38 symptomatic women with cesarean scar defects and remaining myometrial thickness of less than 3 mm, according to magnetic resonance imaging.


Laparoscopic repair of the defect.

Main Outcomes Measure(s)

Increase in myometrial thickness at the site of cesarean section, gynecological and obstetrical outcomes, and histological analysis of the defect after excision.


The mean thickness of the myometrium increased significantly from 1.43 ± 0.7 mm before surgery to 9.62 ± 1.8 mm after surgery. All but three patients were free of symptoms. Among the 18 women with infertility, eight (44%) became pregnant and delivered healthy babies by cesarean section at 38–39 weeks of gestation. Histological analysis, performed in all 38 cases, revealed the presence of endometriosis in eight women (21.1%). Muscle fiber density was significantly lower compared with adjacent myometrium.


In symptomatic women with residual myometrial thickness of less than 3 mm who wish to conceive, laparoscopic repair could be considered an appropriate approach.

Read the full text here.

Fertility and Sterility

Editorial Office, American Society for Reproductive Medicine

Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders. 


Go to the profile of Murat Api
about 3 years ago

I read with great interest the manuscript of Donnez et al. (1). They nicely presented outcomes after laparoscopic repair of a cesarean scar defect in a series of 38 women. In discussion although they referred our idea as the primary source of information (2) several times by my name and collagues as the reference number 21, they did not used it in the bibliography, rather they referred the Grace and Nezhat’s paper (3) who commented on our paper afterwords.
Referencing is a way to give credit to the writers from whom you have borrowed words and ideas. Every submitted academic manuscript is deserved to be scrutinised several times before it is accepted for publication. Correct referencing allows you to acknowledge the contribution of other writers and researcher in your work. In most of the medical journals the process starts with editors, progresses via reviewers and continues even after acceptance when editorial assistants will locate sources in the reference list and ensure that the citations are accurate. By citing the work of a particular scholar you acknowledge and respect the intellectual property rights of that researcher.
Referencing is a way to provide evidence to support the assertions and claims in your own assignments. By citing experts in your field, you are showing your marker that you are aware of the field in which you are operating.
References should always be accurate, allowing your readers to trace the sources of information you have used. Your manuscript is much more likely to survive the rigours of the review process with minimal criticism and positive feedback if all references are contemporaneous, refer to a primary source and have been accurately and correctly cited (4).


Murat Api MD, PhD


1. Donnez O, Donnez J, Orellana R, Dolmans MM. Gynecological and obstetrical outcomes after laparoscopic repair of a cesarean scar defect in a series of 38 women. Fertil Steril. 2017;107(1):289-296.

2. Api M, Boza A, Gorgen H, Api O. Should cesarean scar defect be treated laparoscopically? A case report and review of the literature. J Minim Invasive Gynecol. 2015;22(7):1145–1152.

3. Grace L, Nezhat A. Should Cesarean Scar Defect Be Treated Laparoscopically? A Case Report and Review of the Literature. J Minim Invasive Gynecol. 2016;23(5):843.

4. Santini A. The Importance of Referencing. J Crit Care Med (Targu Mures). 2018; 4(1): 3–4.