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.
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.