Advances in Surgical Sciences
Volume 6, Issue 2, December 2018, Pages: 72-80
Received: Nov. 1, 2018;
Accepted: Nov. 21, 2018;
Published: Dec. 19, 2018
Views 1021 Downloads 150
Andres Vigueras Smith, Department of Gynecology, Sugisawa Hospital, Curitiba, Brazil
Monica Tessmann Zomer Kondo, Department of Gynecology, Sugisawa Hospital, Curitiba, Brazil
Carlos Trippia, Department of Radiology, Nossa Senhora das Graças Hospital, Curitiba, Brazil
William Kondo, Department of Gynecology, Sugisawa Hospital, Curitiba, Brazil
The present review aims to analyze the current data available on the different endoscopic surgical techniques described for Isthmocele treatment. A semantic review of literature was made of all english language publications on databases Pubmed and Google Scholar following a Mesh and key word searching. The studies were finally selected by one author according to the aim of this review. The isthmocele, defined as a defect of the anterior wall of the uterine cervical canal at the site of a previous cesarean section scar, is a prevalent condition in women submitted to gynecological endoscopic procedures. Epidemiological studies report a 1.9% of cesarean scar defects, rising in the last decades, and it is clear that the repair carrie benefits in terms of symptom control and sub-fertility. The minimally invasive approach is the gold standard due the inherent benefits in quality and magnification of image, less postoperative pain, hospital stay and minor complications rate. It can be treated either by laparoscopy or hysteroscopy according to the presentation of the disease and the preference of the surgical team, since both have the same efficacy in symptoms improvement (59% to 90%). Laparoscopy is usually indicated when overlying myometrial mantle is less than 3 mm, and allows an increase in postoperative myometrial streght. Different surgical techniques have been described and supposedly, there is no significant difference among them. Large analytical prospective experimental studies are required to confirm the results of this data and to investigate as to whether there is a better laparoscopic technique.
Andres Vigueras Smith,
Monica Tessmann Zomer Kondo,
Isthmoplasty: Surgical Techniques and Review of Literature, Advances in Surgical Sciences.
Vol. 6, No. 2,
2018, pp. 72-80.
Gubbini G, Casadio P, Marra E. Resectoscopic correction of the isthmocele in women with postmenstrual abnormal uterine bleeding and secondary infertility. J Minim Invasive Gynecol 2008; 15: 172- 175.
Armstrong V, Hansen WF, Van voorhis BJ, Syrop CH. Detection of Cesarean scars by transvagi- nal ultrasound. Obstet Gynecol 2003; 101: 61- 65.
Darwish A. Fertility-oriented Female Reproductive Surgery , Microsurgical Cesarean Section 5. January 18th 2017. DOI: 10.5772/67123.
Diaz SD, Jones JE, Seryakov M, Mann WJ. Uterine rupture and dehiscence: ten year review and case control study. South Med J. 2002; 95:431–5.
Muzzi L, Domenici L, Lecce F et al. Clinical outcomes after resectoscopic treatment of cesarean-induced isthmocele: a prospective case-control study Eur Rev Med Pharmacol Sci 2017; 21:3341-3346.
Bij de Vaate AJ, Van der Voet LF, Naji O , et al. Prevalence, potential risk factors and development of uterine niches following cesarean section: systematic review. Ultrasound Obstet Gynecol 2014; 43:372-382.
Tulandi T, Cohen A. Emerging manifestations of cesarean scar defect in reproductive‐ aged women. J Minim Invasive Gynecol. 2016 Sep–Oct; 23(6):893–902.
Nezhat C, Soliemannjad R, Razavi GM, Nezhat A. Cesarean Scar defect: what is and how should it be treated? OBG Management. 2016; 28(4): 32-53.
Nazik, H, Nazik E. A new problem arising after cesarean, cesarean scar defect (Isthmocele) a case report. Obstet Gynecol Int J 2017, 7(5): 00264.
Morris H. Surgical pathology of the lower uterine segment cesarean segment scar: is the scar a source of clinical symptoms?. Its J Gynecol Pathol.1995; 14: 16-20.
Florio P, Filippeschi M, Moncini I, Gubbini G. Hysteroscopic treatment of the cesarean induced isthmocele in restoring infertility. Curr Opin Obstet Gynecol. 2012; 24(3): 180–6.
Vervoort A, Van der Voet LF, Hehenkamp WJK et al. Hysteroscopic resection of a uterine caesarean scar defect (niche) in women with postmenstrual spotting: a randomized controlled trial. BJOG.2017. DOI: 10.1111/1471-0528.14733.
Roberge S, Demers S, Girard M, Vikhareva O, et al. Impact of uterine closure on residual myometrial thickness after cesarean: a randomized controlled trial. Am J Obstet Gynecol. 2016. 214: 507. e1-6.
Osser OV, Jokubkiene L, Valentin L. Cesarean section scar defects: agreement between transvaginal sonographic findings with and without saline contrast enhancement. Ultrasound Obstet Gynecol. 2010; 35: 75-83.
Bharatam KK. Cesarean section uterine scar dehiscence—a review. Uterus Ovary. 2015; 2: e751.
Vervoort AJ, Ui enbogaard LB, Hehenkamp WJ, Brölmann HA, Mol BW, Huirne JA. Why do niches develop in Caesarean uterine scars? Hypotheses on the etiology of niche development. Hum Reprod. 2015; 30(12): 2695–702.
O li‐Yebovi D, Ben Nagi J, Sawyer E, et al. De cient low‐segment cesarean section scars: prevalence and risk factors. Ultrasound Obstet Gynecol. 2008; 31: 72–77.
Hayakawa H, Itakura A, Mitsui T, Okada M, Suzuki M, Tamakoshi K, Kikkawa F. Methods for myometrium closure and other factors impacting effects on ce- sarean section scars of the uterine segment de- tected by the ultrasonography. Acta Obstet Gyne- col Scand 2006; 85: 429-434.
Florio P, Gubbini G, Marra E, Dores d, et al. A retrospective case–control study comparing hysteroscopic resection versus hormonal modulation in treating menstrual disorders due to isthmocele. Gynecol Endocrinol. 2011; 27: 434-438.
Tower AM, Frishman GN. Cesarean scar defects: an under recognized cause of abnormal uterine bleeding and other gynecologic complications. JMIG. 2013 Sept- Oct; 20(5): 562-572.
Zeirideeen R. Should Laparoscopy be the Gold Standard of Isthmocele ?World Journal Laparoscopic Surgery. September-december 2016; 9(3): 118-121.
Klemm P, Koehler C, Mangler M, Schenider U, Schneider A. Laparoscopic and vaginal repair of uterine scar dehiscence following cesarean section as detected by ultrasound. J perinatal Med. 2005; 33: 324-31.
Stewart KS, Evans TW. Recurrent bleeding from the lower segment scar--a late complication of Cae- sarean section. Br J Obstet Gynaecol. 1975; 82: 682-686.
Thurmond AS, Harvey WJ, Smith SA. Cesarean section scar as a cause of abnormal vaginal bleeding: Diagnosis by sonohysterography. J Ultrasound Med. 1999 Jan; 18(1): 13-16.
Marotta MI, Donnez j, Squifflet J et al. Laparoscopic repair of post-cesarean section uterine scar defects diagnosed in non pregnant women. J Minim Invasive Gynecol. 2013; 20: 386-391.
Tanimura S, Funamoto H, Hosono T et al. New diagnostic criteria and operative strategy for cesarean sac syndrome. Endoscopic repair for secondary infertility caused by cesarean scar defect. J Obstet Gynecol res. 2015; 41: 1363-9.
Urman B, Arslan T, Aksu S, Taskiran C. Laparoscopic repair of cesarean scar defect “isthmocele”. J Minim Invasive Gynecol. 2016; 23(6): 857–8.
Van der Voet LF, Vervoort AJ, Veersema S, Bij de Vaate AJ, Brölmann HA, Huirne JA. Minimally invasive therapy for gynaecological symptoms related to a niche in the caesarean scar: a systematic review. BJOG. 2014; 121: 145-156.
Li C, Tang S, Gao X, et al. Efficacy of combined laparoscopic and hysteriascopic repair of post-cesarean section uterine diverticulum: A retrospective analysis. Biomed Research International. 2016; 2016: 1765624. DOI: 10.1155/2016/1765624.
Gubbini G, Casadio P, Franchini M. Small Size Resectoscope in Itsthmocele repair: Case Report. Obstet Gynecol Int J. 2017 7(5) : 00262. DOI:10.15406/ogij.2017.07.00262.
Donnez O, Donnez J, Orellana R, Dolmans MM. Gynecological and obstetrical outcomes after laparoscopic repair of cesarean scar defect in a series of 38 women. Fertil Steril. 2017 107(1): 289-296.
Luo L, Niu G, Wang Q, Xie HZ, Yao SZ. Vaginal repair of cesarean section scar diverticula. J Minim Invasive Ginecol. 2012 19(4): 454-458.
Yalcinkaya TM, Akar ME, Kammire LD, Johnston-Macananny EB, Mertz HL. Robotic assisted laparoscopic repair of symptomatic cesarean scar defect: a report of two cases. J Reprod Med . 2011; 56(5-6): 265-270.
Setubal A, Alves J, Osorio F, et al. Treatment of uterine Isthmocele. A pouch like defect at the Site of a Cesarean Section Scar. Journal of minimally Invasive Gynecology. September 5, 2017. DOI:10.1016/j.jmig.2017.09.022.
Jacobson MT, Osias J, Velasco A, Charles R, Nezhat C. Laparoscopic repair of a utero-peritoneal fistula. JSLS. 2003; 7: 367–369.
Donnez O, Jadoul P, Squifflet J, Donnez J. Laparoscopic repair of wide and deep uterine scar dehiscence after cesarean section. Fertil Steril. 2008; 89: 974–980.
Zhang X, Wu C, Yang M et al. Laparoscopic repair of cesarean section scar defect and surgical outcome in 146 patients. Int J Clin Exp Med. 2017; 10(3): 4408-4416.
Bakaviciute G, Spiliauskaite S, Meskauskiene A, Ramasaukaite D. Laparoscopic repair os the uterine scar defect- successful treatment os secondary inherit city: a case report and literature review. Acta media lituanica. 2016. Vol. 23. No. 4. P.227––2231.
Surgical Tutorial 5 : Isthmocele. Presented in the 45th global congress AAGL; November 14 - 18, 2016; Orlando Florida,
Nirgianakis K, Oehler R, Mueller M. “ e Rendez-vous technique for treatment of caesarean scar defects: a novel combined endoscopic approach,” Surgical Endoscopy. 2016; vol. 30, no. 2, pp. 770–771.
Liu S, Ly W, Li W. Laparoscopic repair with hysteroscopy of cesarean scar diverticulum. J Obstet Gynaecol Res. 2016; 42: 1719–1723.
Fabres C, Arriagada P, Fernandez C et al. Surgical treatment and follow-up of women with intermenstrual bleeding due to Cesarean section scar defect. Journal of Minimally Invasive Gynecology .2005; 12, 25-28.
Raimondo G, Grifone G, raimondo D , et al. Hysteroscopoic treatment of symptomatic cesarean induced isthmocele: A prospective study. J Minim Invasive Gynecol. 2015 22(2): 297-301
Xie H, Wu Y, Yu F, He M, Cao M, Yao S. A comparison of vaginal surgery and operative hysteroscopy for the treatment of cesarean- induced isthmocele: a retrospective review. Gynecol Obstet Invest. 2014; 77: 78–83.
Zhang X, Yang M, Wang Q, Chen J, Ding J, Hua K. Prospective evaluation of five methods used to treat cesarean scar defects. Int J Gynaecol Obstet. 2016; 134: 336–339.
Zhang Y. A comparative study of transvaginal repair and laparoscopic repair in the management of patients with previous cesarean scar defect. J Minim Invasive Gynecol. 2016; 23: 535–541.
Mahmoud MS, Nezhat FR. Robotic‐assisted laparoscopic repair of a cesarean section scar defect. J Minim Invasive Gynecol. 2015; 22(7): 1135–6.
Schepker N, Garcia-Rocha GJ, von Versen-Hoynck F, Hillemanns P, Schippert C. Clinical diagnosis and therapy of uterine scar defects after caesarean section in non-pregnant women. Arch Gynecol Obstet. 2015; 291: 1417–1423.
Chang Y, Tsay EM, Long CY, Lee CY, Kay N. Resectoscopic treatment combined with sons hysterographic evaluation of women with post menstrual bleeding as a result of previous cesarean delivery. Am J Obstet Gynecol. 2016 200(4): 370.e1-370.e4.
Li C, Guo Y, Liu Y, Cheng J, Zhang W. Hysteroscopic and laparoscopic management of uterine defects on previous cesarean delivery scars. J Perinat Med 2014 42(3): 363-370.
Chen H, Yao J, Wang X. Surgery experience is transvaginal cesarean section diverticulum ( CSD) repair. Gynecol Minim Invas Ther. 2016 5: 148-151.
Gubbini G, Centini G, Nascetti d, Marra E, et al. Surgical hysteroscopic treatment of cesarean-induced isthmocele in restoring fertility: a prospective study. J Minim Invasive Gynecol. 2011; 18: 234-237.
Api M, Boza A, Gorgen H, Api O. Should cesarean sac defect be treated laparoscopically ? A case report and review of the literature. J Minim Invasive Gynecol. 2015; 22(7): 1145-1152.
Vervoort AJ, Uittenbogaard LB, Hehenkamp WJK, Brolman HAM, Mol BWJ, Huirne JAF. Why do niches develop in cesarean uterine scars? Hypotheses on the etiology of niche development. Human retrod. 2015; Dec; 30(12): 2695-2702.
Chen Y, Chang Y, Yao S. Transvaginal management of cesarean scar section diverticulum: a novel surgical treatment. Med Sci Monit. 2014; 20: 1395–9.
Dodd JM, Anderson ER, Gates S, Grivell RM. Surgi- cal techniques for uterine incision and uterine closure at the time of caesarean section. Cochrane Database Syst Rev. 2014; 7: CD004732.
Fabres A, Aviles G, De la Jara C et al. The cesarean delivery scar pouch: clinical implications an diagnostic correlation between transvaginal sonography and hysteroscopy. J Ultrasound Med. 2003; 22 (7): 695-700.